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End of Work-Related Aggravation of Pre-Existing Injury Can Lead to Suspension of Workers’ Compensation Benefits

When a worker is injured on the job and becomes temporarily unable to perform his or her usual work duties, he or she may be entitled to either temporary total disability benefits (if the worker is totally unable to work) or temporary partial disability benefits (if the worker returns to work but earns less than before the injury).

Of course, temporary benefits do not continue forever – hence, the name “temporary.” Generally, these benefits end when an employee returns to their usual work duties or when their medical condition returns to its pre-work-injury state. This is commonly referred to as a return to “baseline”. This concept comes in to play primarily when the injured worker had an injury or pre-existing condition to the same body part prior to his or her work accident. The most popular way for employers to attempt to prove that an injured worker’s injury has returned to baseline in an attempt to suspend benefits is to present medical evidence in the form of statements from the injured worker’s treating physician(s).

Facts of the Case

In a workers’ compensation case recently released by the State Board of Workers’ Compensation, the plaintiff was a man who allegedly sustained a work-related injury to his right knee and hip, due to a 2010 on-the-job accident. In 2013, he had a hip replacement operation through the Veterans Administration Hospital.

In January 2016, an administrative law judge (ALJ) was asked to consider whether the plaintiff’s hip and knee injuries continued to be compensable. The ALJ found in the plaintiff’s favor, directing the defendant employer/insurer to pay the plaintiff temporary total disability (TTD) benefits from the point of his economic disability in 2011 until such time as the benefits were modified or terminated based upon the law. The defendant appealed.

Holding of the Appellate Division

The Appellate Division of the State Board of Workers’ Compensation reversed the ALJ’s decision. On appeal, the defendant argued that the plaintiff was not entitled to TTD benefits because his hip and knee conditions had fully resolved. The appellate division agreed with the defendant as to the issue, noting that the medical evidence contradicted the plaintiff’s testimony that he had never had problems with his hip or knee prior to the work injury. Notably, two separate physicians opined that the work injury aggravated an underlying condition that had been present prior to the plaintiff’s accident at work.

In so holding, the appellate division pointed to a doctor’s statement to the effect that, although the plaintiff’s work injury led to his first seeking medical treatment for his hip and knee, the work injury had resolved by late 2011. As of that point, the doctor opined that the plaintiff’s pain was a result of “underlying, pre-existing degenerative joint disease,” rather than the work injury. The appellate division also noted that the reason the plaintiff left work in 2011 was to have surgery on his foot for a condition unrelated to the work injury. Inasmuch as he was released to return to work without restrictions in 2012, the ALJ erred in finding him entitled to TTD from 2011 forward.

Talk to a Helpful Atlanta Workers’ Compensation Lawyer

A knowledgeable Atlanta workers’ compensation lawyer at the Law Offices of T. Andrew Miller, LLC, can help you understand your legal rights under the Georgia workers’ compensation laws. Call us at 678-605-9109 to schedule a free consultation regarding your work injury in the greater Atlanta or Fulton County area. There are strict deadlines for the giving of notice and filing of a claim for workers’ compensation benefits, so do not delay in taking appropriate legal action.