A compensable work injury is rarely a simple matter. In addition to the many issues that arise regarding the treatment of the injury and the return of the claimant to the workforce, there is the potential for complication when an injured part affects and incapacitates another part that was not affected in the underlying accident.
A compensable work injury is rarely a simple matter. In addition to the many issues that arise regarding the treatment of the injury and the return of the claimant to the workforce, there is the potential for complication when an injured part affects and incapacitates another part that was not affected in the underlying accident. This is known as a superadded injury. A claimant sustains a compensable superadded injury when, as a result of a work-related disability to one part of the , the employee suffers a disabling injury to another part of the . Superadded injuries are generally considered compensable because they constitute either a change in the employee's condition or a new accident. A superadded injury may occur as a result of the employee’s customary activity in light of his or her condition, but it may also occur as a result of medical treatment undertaken to cure the work-related injury.
In a recent decision, City of Atlanta v. Roach, 2009 Ga. App. LEXIS 440 (Ga. Ct. App. 2009), the Court of Appeals addressed a claim that a superadded injury occurred as a result of such medical treatment. The Court inRoach reversed the superior court and upheld the State Board’s finding that a claimant’s third-degree burns to his hip from a heating pad were not a compensable superadded injury to his left hip fracture, where the heating pad was not prescribed by a physician and the circumstances in which claimant used the device did not constitute reasonable and necessary medical treatment. Despite a very sympathetic claimant, the Court of Appeals agreed that the burn did not arise as a natural consequence of the original work injury to the hip.
The claimant in Roach, a policeman for the City of Atlanta, was injured in an on-the-job accident in 2004, when his police cruiser was struck head-on by a drunk driver and burst into flames, and the claimant had to be physically extracted from the vehicle. He was placed in a medically-induced coma for two weeks due to traumatic brain injury, and also fractured his left hip and pelvis.
In 2005 he was assigned a 12% whole- impairment rating, with medium-duty work capabilities. The claimant moved to New York, and in 2006 he drove to Atlanta to meet with his commanding officer to discuss returning to work. He made the 16-hour drive in one day, and his left hip was sore when he arrived in Atlanta. He placed a heating pad on his hip and fell asleep, awaking to find the heating pad caused third-degree burns to his leg. According to the claimant, he could not feel the burns due to nerve damage from his hip surgery.
The ALJ found that the burn was related to the original injuries and usage of the heating pad was reasonable and necessary for the hip injury, and awarded medical expenses and attorney fees. The Board reversed, finding that the burn to the left hip in 2006 did not arise as a natural consequence of the work-related hip fracture of 2004. The Board relied on claimant’s testimony that the burn occurred because he fell asleep on the heating pad, and found that the burn did not result from reasonably required medical treatment prescribed for the original hip injury, because no doctor prescribed the use of a heating pad.
The superior court disagreed, concluding that the heating pad usage was a consequence of the original hip injury, and rejecting what it saw as the Board’s requirement that a superadded injury must result from medical treatment prescribed by the physician. The superior court also found that the record did not show that use of the heating pad was unreasonable or unnecessary; that is, the court wanted the Employer/Insurer to show that the claimant was acting unreasonably in using the heating pad.
The Court of Appeals reversed the superior court and upheld the Board’s award. The Court agreed that the Board properly relied on J.M. Huber Corp. v. Holliday, 228 Ga. App. 4, 491 S.E.2d 74 (1997), for the proposition that a superadded injury arises as a natural consequence of, or directly from, the original event and is not the result of a new event or accident. The Board found that the burn did not arise as a natural consequence of the hip fracture from two years earlier, but rather from claimant using a heating pad and falling asleep, and the superior court was bound by the Board’s findings of fact because there was some evidence in the record to support them.
The Court also held that the superior court erred in reversing the Board’s finding that the burn was not a superadded injury because it did not result from authorized or prescribed medical treatment. The heating pad was not prescribed, and the claimant admitted using the heating pad for other parts of his not related to his work injuries. Viewed in the light most favorable to the Employer/Insurer, there was some evidence to support the Board’s finding that the prolonged use of a heating pad — not prescribed by a physician — while sleeping was not reasonable and necessary medical treatment, so that the resultant burn was not an incapacitation resulting from medical treatment undertaken to cure the work-related hip injury.
Roach is distinguishable from other cases in which medical treatment was prescribed and undertaken to address the underlying work-related injury, and such treatment resulted in aggravation or incapacitation of another part. For example, in Noles v. Aragon Mills, 116 Ga. App. 560, 158 S.E.2d 261 (1967), the claimant injured his left leg, requiring treatment including surgical removal of skin from his right thigh to graft onto the left leg, and this constituted a superadded injury to the right leg while it was incapacitated due to the medical treatment. The subsequent incapacitation in Roach resulted from claimant’s actions and not from any prescribed medical treatment that was reasonable and necessary to the hip fracture, and for this reason did not constitute a superadded injury. Roach is also distinguishable from cases where the nature of the injury and the course of the treatment directly resulted in further incapacitation, because the burn injury in Roach was not a natural consequence or direct effect of the original hip fracture. It is thus different from cases such as National Surety Corp. v. Martin, 86 Ga. App. 77, 71 S.E.2d 666 (1952), where a fractured leg bone failed to knit, resulting in damage to hip socket, because the hip fracture in Roach did not directly lead to the burns.
Superadded injury cases will continue to rely on fact-intensive analysis on a case by case basis. However, Roach clearly stands for the proposition that a claimant does not sustain a superadded injury where the injury arose as a result of the claimant’s unreasonable self-treating and not as a result of prescribed medical treatment. It seems that the Court would have reversed the Board, had a physician prescribed the heating pad, although it is possible that the Board would still have found the claimant’s prolonged use while asleep to have been unreasonable and unnecessary. In any event, after Roach, an Employer/Insurer may argue that, when an injury results from behavior the claimant contends was medical treatment but which was not authorized by a physician and not necessary, the result is not a compensable superadded injury. Though this is a very limited defense against a claimed superadded injury, when the facts of a future claim aligns with those of Roach, the Employer/Insurer should be able to defeat the superadded injury claim.