A recent Georgia Supreme Court decision, Roseburg Forest Products Company v. Barnes, has far reaching implications for Employers and Insurers when evaluating catastrophic claims…
A recent Georgia Supreme Court decision, Roseburg Forest Products Company v. Barnes, has far reaching implications for Employers and Insurers when evaluating catastrophic claims. No. S15G1808, S15G11811 2016 WL 3147567 (Ga. June 6, 2016). The unanimous Court reiterated that the statutes of limitation within the Georgia Workers’ Compensation Act were enacted by the legislature for the purpose of lending finality to claims and should be afforded a plain, unambiguous reading. Under O.C.G.A. § 34-9-104(b), if the employee does not file a claim for benefits within two years of his alleged change in condition, then his claim is time barred, no matter if the claim was previously accepted as catastrophic under the Act. Likewise, an employee seeking to file a claim for a new accident must file his claim within one year of the job related injury or within year of when Employer/Insurer last furnished remedial medical treatment.
In issuing this decision, the Georgia Supreme Court reversed the Court of Appeals, which had reversed superior court, who affirmed the State Board of Workers’ Compensation Appellate Division’s holding adopting the Administrative Law Judge’s decision that the injured worker’s claim for reinstatement of temporary total disability benefits (TTD) was time barred pursuant to the two year change in condition statute of limitations, O.C.G.A. § 34-9-104(b) and the one year statute of limitations for fictional new accidents, O.C.G.A. § 34-9-82.
By way of background, the claimant was injured while working for Georgia Pacific in August of 1993, when his left leg slipped through a rotten floor and was entrapped in an auger; necessitating a below the knee amputation. After his leg was amputated, Georgia Pacific and its insurer, Georgia Conversion Primary Ins. Co., accepted the claim as catastrophic under O.C.G.A. § 34-9-200.1(g)(2), the portion of the Act defining a catastrophic injury as one involving the amputation of an arm, a hand, a foot, or a leg, and TTD benefits were commenced. After being fitted with a prosthetic leg, the claimant returned to work for Georgia Pacific in January of 1994. At that time, his TTD benefits were suspended, and permanent partial disability (PPD) benefits were commenced. Of note, while the claimant was not able to return to his former job, he was transferred to a supervisory/light duty position, where the ALJ found that he continued to work despite the pain. The claimant’s last PPD payment was issued in May of 1998, and he did not receive any workers’ compensation indemnity benefits thereafter.
In 2006, Georgia Pacific sold the plant to Roseburg Forest Products Company (Roseburg), who acquired all of Georgia Pacific’s assets and liabilities. During the 2006 takeover, Roseburg eliminated the claimant’s supervisory position and transferred him to another position within the plant that increased the physical demand on his prosthesis and caused increased pain and swelling in his left leg. Three years later, On September 10, 2009, Roseburg eliminated the claimant’s position, and he was laid off. The claimant then asked Roseburg to reinstate his TTD benefits, but he was told that he was ineligible.
In August of 2012, 18 years after the claimant returned to work and more than 14 years after his last workers’ compensation indemnity check was issued, the claimant filed a WC-14 Notice of Claim against Georgia Pacific asserting a 1993 date of injury and requesting resumption of TTD benefits. The claimant asserted that he was catastrophically injured in 1993, and although he continued to work with limitations, he remained catastrophically injured. Thus, he was entitled to receive TTD benefits from the date that he ceased working. Georgia Pacific controverted the claim on the grounds that the claimant was no longer an employee. Roseburg and its insurer/servicing agent, Ace American Ins. Co. (Ace American) c/o CCMSI, later controverted the claim as well, based on the defense that the two year statute of limitations set out in O.C.G.A. § 34-9-104(b) had expired. In November of 2012, the claimant filed a separate claim against Roseburg and Ace American/CCMSI alleging an injury date of September 10, 2009 and contending that his termination constituted a fictional new accident under O.C.G.A. § 34-9-82.
I.Claimant’s First Theory of Recovery—Change in Condition
The Court found that the Court of Appeals had incorrectly held that O.C.G.A. § 34-9-104(b) did not bar the claimant’s request for resumption of TTD benefits. The Court articulated that a claimant is permitted to file a claim for reinstatement of benefits, when he experiences a change in condition pursuant to O.C.G.A. § 34-9-104(a)(1), but only if that change occurs more within two years since of the last indemnity payment. The Court reasoned that
“statutes of limitation are designed to promote justice by preventing surprises through the revival of claims that have been allowed to slumber until evidence has been lost, memories have faded, and witnesses have disappeared; the theory is that even if one has a just claim, it is unjust not to put the adversary on notice to defend within the period of limitation, and that the right to be free of stale claims in time comes to prevail over the right to prosecute them.” Roseburg at *2 (Ga. June 6, 2016).
The Court dismissed the open-ended exception that the Court of Appeals attempted to carve out due to the fact the claimant would have been eligible for lifetime TTD benefits should he not have returned to work following his injury. The Court iterated that regardless of the claimant’s right to receive weekly TTD benefits for his catastrophic injury until such time as he experienced a change in condition under O.C.G.A. § 34-9-104(a)(1), he must file a claim to enforce that right within two years of the last payment of TTD benefits. Accordingly, the claimant filed his claim to assert his right to resume TTD benefits for his catastrophic injury some 16 years too late. Id.
II.Claimant’s Second Theory of Recovery—Fictional New Date of Accident
Next, the Court examined the claimant’s contention that he suffered a fictional new accident pursuant to O.C.G.A. § 34-9-82 on the day that he was terminated from Roseburg, September 10, 2009. The Court continued with its dismissal of the Court of Appeals’ line of reasoning that barring the claimant’s claims would lead to an unjust result, by first discussing the plain language of O.C.G.A. § 34-9-82(a), which states in part,
“The right to compensation shall be barred unless a claim is filed within one year after injury, except that if payment of weekly benefits has been made or remedial treatment has been furnished by the employer on account of the injury the claim may be filed within one year after the date of the last remedial treatment furnished by the employer or within two years after the date of the last payment of weekly benefits.” Id at *3.
While refusing to discuss the substantive merits of the claimant’s fictional new injury claim, the Court elucidated that because the claimant last received remedial treatment on November 30, 2009 for chronic knee pain that he alleged was related to his fictional new injury, he therefore had until November 30, 2010 file his claim. Because he did not file his claim until November 30, 2012, it was also time barred.
Importantly, the Court then clarified the fact that even though the claimant sought additional treatment in December of 2011 and had been fitted with a new prosthesis, furnished by CCMSI, his November 30, 2012 claim asserting a fictional new date of injury was barred by the one-year statute of limitations for filing a new claim O.C.G.A. § 34-9-82. Obtaining treatment after the statute of limitations already expired did not revive his already stale claim. Citing earlier case law on point, where injured workers had gone more than one year between medical treatment, the Court rationalized that holding otherwise would defeat the entire purpose of the statute of limitations; bringing closure and finality to a claim. Leaving the Court of Appeals’ decision intact would have allowed an injured worker to resuscitate a stale claim by seeking medical treatment, whether treatment is sought months or decades after the claim was extinguished under the statute.
Recommendations for Employers/Insurers
By issuing this unanimous decision, the Georgia Supreme Court corrected a misinterpretation of the law that could have revived claims that had been time barred for 20 years or more. The decision reiterates that both statutes of limitation, O.C.G.A. § 34-9-82 and O.C.G.A. § 34-9-104(a) apply across the board to all claims, including catastrophic claims. By reading the statutes of limitation to a have plain, unambiguous meaning and giving them full effect, the Court restored their potency and reinforced their finality. Practically speaking, the claimant in this case was not without remedy, as he should have filed a claim for a fictional new accident within one year of the medical treatment that he received on November 30, 3009, or in the alternative, within one year of his termination on September 10, 2009.
Another practical take-away from this decision can be found in footnote 5 of the opinion, where the Court dealt with the argument from Roseburg that its insurer, Ace American, was not the alter ego of Roseburg for the purposes of the claim. Ace American attempted to argue that because the prosthesis was furnished by its servicing agent, CCMSI, the claim against Roseburg/Ace American would be barred because CCMSI is not the alter ego of Roseburg. The Court stated that both Ace American and CCMSI are the alter egos of Roseburg for the purposes of the workers’ compensation claim. Regardless of whether CCMSI or Ace American furnished the prosthesis, Roseburg is the entity ultimately responsible under Georgia law, and treatment funded by CCMSI or Ace American is imputed to Roseburg as a matter of law. Roseburg at *4. The Court cited O.C.G.A. § 34-9-82(a) and highlighted the legislature’s use of the word employer, rather than insurer, when discussing the furnishing of remedial treatment.
Globally, the Roseburg decision stands for the fact that statutes of limitation have no exceptions, and when they expire, the claim, regardless of classification, is extinguished.