When someone is hurt at work, his or her employer (or its workers' compensation insurance carrier) must provide certain medical benefits to the employee.
However, this is not a blank check for the injured worker to have any and all medical treatment that he or she believes would help alleviate the problems caused by the work accident. Instead, there are certain rules and procedures that must be followed in order for there to be an obligation upon the employer or its insurer to pay for a particular treatment. As with other issues in Georgia workers' compensation cases, the employee has the burden of proof in convincing the workers' compensation board that he or she is entitled to the relief sought.
Facts and Issues
The claimant in a recently reviewed workers' compensation case was a 44-year-old woman who was injured in a motor vehicle accident in November 2010. At the time of the crash, the woman was working as a clerk and delivery driver for a certain employer. The woman's neck and back were injured in the accident, and she was off from work for a short time after the accident. She returned on light duty but resumed her regular job about five or six weeks later. In June 2011, the claimant was placed at maximum medical improvement and released to her full work duties. Two months later, she moved to Florida.
In 2016, an administrative law judge was asked to decide whether the employer had an obligation to pay for a certain medical procedure (a sacroiliac joint fusion) that the claimant averred was reasonable and necessary as a result of her work-related injury in 2010.
Decision of the ALJ
The administrative law judge denied the claimant's request for authorization and payment of the surgery and ruled that neither the employer nor its insurer was liable for the treatment because the claimant had failed to prove that it was reasonable and necessary based on her work injury. The judge based his opinion on a particular doctor's finding that the claimant had no sacroiliac joint dysfunction as of April 2015. (The full board affirmed the judge's decision.)
Although the doctor whom the claimant wished to perform the surgery opined that the claimant's joint dysfunction "could be" associated with her work-related motor vehicle accident, the judge found that this did not meet the applicable standard of evidence. According to the judge, an equivocal statement from a doctor that only raises a conjecture or possibility did not satisfy the claimant's burden of proving that the treatment at issue was rendered necessary due to her accident at work.
Get Help with Your Atlanta Workers' Compensation Case
If you need to speak with an experienced Atlanta workers' compensation lawyer about a work-related injury or accident, the Law Office of T. Andrew Miller, LLC, is here for you. We offer a free, confidential case evaluation to discuss the merits of your case; to take advantage of this opportunity, phone us today at 678-894-4758 and schedule an appointment. You should not delay in seeking legal advice about your case, since missing an important deadline could keep you from recovering what you are due.