The workers’ compensation system is a microcosm of American society as a whole and there are times when injured
The workers’ compensation system is a microcosm of American society as a whole and there are times when injured workers are incarcerated after the commission of a crime. Fortunately, these situations are few and far between. However, it is essential that employers and insurers understand their rights and obligations when dealing with an injured worker who is incarcerated. While there are any number of potential issues that may arise when a claimant is arrested after the commission of a crime, the most common problem relates to the injured workers ongoing entitlement to income benefits after an arrest.
The gut reaction would be to immediately suspend temporary total disability benefits upon learning of a claimant’s incarceration. Incarceration is effectively a removal of an injured employee from the workforce as the result of a willful criminal act which would preclude him from accepting any job position or earning a wage regardless of his work injury. Therefore, it stands to reason that a party responsible for the payment of lost wage benefits through the workers’ compensation system should be entitled to suspend these benefits as long as the injured worker is incarcerated.
Despite this inclination, Georgia law has very clear guidelines addressing when it is and is not appropriate to suspend indemnity benefits. In Georgia, whether an injured worker is entitled to receive temporary total disability benefits during periods of incarceration is largely a function of case law and the central question that must be addressed in every case is whether there has been an adjudication of guilt. Where a claimant is receiving temporary total disability benefits but becomes incarcerated prior to a conviction of a crime, then the claimant is entitled to continue to receive weekly temporary total disability benefits. Howard v. Scott House. Sys., 180 Ga. App. 690 (1986).
On the other hand, when a claimant is receiving income benefits and is incarcerated after the conviction of a crime, the employer/insurer is justified to suspend benefits from the date of conviction forward. Howard v. Scott House. Sys., 256 Ga. 675 (1987). Clearly, the courts hesitation to grant employers and insurer’s the right to suspend temporary total disability benefits prior to an adjudication of guilt is rooted in the fundamental principle of our judicial system that criminal defendants are innocent until proven guilty and not abiding by these principles would be a violation of due process under the law.
Despite the apparent clarity the Courts have provided with regard to the appropriate time to suspend income benefits when a claimant is incarcerated, the answer is not as simple as it may seem, which is highlighted by the following hypothetical situation:
A claimant is arrested, while receiving temporary total disability benefits and charged with a number of serious crimes. Due to his limited income, he is unable to post bail and remains incarcerated while his case is pending. Since there had been no adjudication of guilt, the employer/insurer continues to direct deposit the claimant’s weekly indemnity check into his bank account. Ultimately, the claimant pleads guilty and due to the length of his incarceration he is sentenced to time served.
In this instance, the claimant was essentially given a retroactive sentence dating back to his initial date of incarceration. Because the there was an adjudication of guilt and the sentence covers the entire incarceration period during which the claimant received income benefits, is arguable that the employer/insurer is entitled to the reimbursement of all income benefits paid while the claimant was incarcerated even though he was not incarcerated at any point after his adjudication of guilt. Clearly, this is an issue that would need to be addressed by an Administrative Law Judge at an evidentiary hearing and there is no clear answer as to whether the employer/insurer would be entitled to a reimbursement. However, this fact pattern highlights the point that there is no one size fits all solution to the issues that may arise.
Another issue that will most certainly arise after an injured worker is incarcerated after an adjudication of guilt is what to do when he is released. Due to overcrowding in America’s prisons, unless a criminal defendant is convicted of a serious offence, the odds are that he will be incarcerated for a relatively short period of time. As a result, in most claims, the injured worker who is incarcerated will be released from prison at some point prior to the passing of the indemnity benefit cap. Therefore, employers and insurers will be put in a situation where they must decide whether it is necessary to recommence the injured workers’ temporary total disability benefits after his release from prison.
It could be argued that incarceration after the conviction of a crime is the quintessential change in condition since the injured workers has, through his own actions, which are completely unrelated to his work accident, taken himself out of the workforce, barring him from earning a wage. Therefore, it could be asserted that upon his release from prison or jail, the burden should shift to the claimant to establish his ongoing entitlement to income benefits.
However, practically speaking, if the injured worker is totally disabled by the authorized treating physician at the time of his incarceration and is incarcerated for a limited period of time, an Administrative Law Judge may order the recommencement of indemnity benefits upon the injured workers release if this issue is taken up at an evidentiary hearing. Of course, the employer/insurer can still argue that the worker in question has experienced a change in condition at hearing. However, if the claimant is totally disabled at the time of his incarceration, it may be prudent to recommence benefits upon his release in order to avoid potential penalties and fees and simultaneously file a hearing request seeking the suspension of benefits based on a change in condition if there is evidence to this.
On the other hand, if the claimant in question is not totally disabled at the time of his incarceration but is receiving temporary total disability benefits due to an unavailability of light duty work, it is arguable that the claimant should have to prove that his current inability to find gainful employment is causally related to his work accident. Obviously, being convicted of a serious crime would affect any prospective employee’s ability to find work and it certainly could be argued that the claimant should have the burden to show that he has made a diligent effort to find suitable employment and has been unable to do so because of his work injury, in accordance with the Georgia Supreme Court decision in Maloney v. Gordon Farms. Therefore, in this situation, the employer/insurer may be best served by not immediately recommencing benefits and argue that the burden has shifted to the claimant to establish his ongoing entitlement to income benefits.
There are a multitude of other issues that may arise when a claimant is incarcerated after the commission of a crime. Because the statutes provide little guidance and there is relatively few binding court decisions addressing these problems, it is essential that employers and insurers address tackle these issues on a case by case basis and seek the advice of counsel when a claimant in a compensable case is arrested.
The Journal is a publication for the clients of Drew Eckl & Farnham, LLP. It is written in a general format and is not intended to be legal advice applicable to any specific circumstance. Legal opinions may vary when based upon subtle factual differences. All rights reserved.