Quick Definitions: Administrative Law Judge

The Administrative Law Judge, or ALJ, is the judge that is assigned to preside over a workers' compensation case through the initial hearing. Prior to the hearing, the ALJ makes decisions on any motions filed by the parties and has the authority to schedule or continue the hearing, among other things. At the hearing, the ALJ hears and receives all evidence from both parties and issues a written decision determining the outcome of the case.

I was working two jobs when I got hurt. Does this affect the amount I receive in weekly benefits?

It depends. Whether a second job affects your compensation rate (how much money you receive in weekly benefits) depends on a couple of things. First, were you employed by the two jobs at the same time? If not, then any wages you earned at the second job will not be taken into account when determining your compensation rate.

However, if you were employed concurrently at the two jobs, such as in the question asked in the topic of this post, the question then becomes whether the two jobs were substantially similar in the eyes of the Administrative Law Judge at the hearing. If the two jobs were so similar in nature with respect to job description, duties, and/or physical requirements, then the wages you earned at the second job will be taken into account when your compensation rate is calculated. If the jobs were different, then your compensation rate is calculated only using the wages you earned at the job where you were injured. This doctrine, known as "concurrent similar employment," is often an issue that is contested by the parties to a workers' compensation claim due to the factually-specific nature of the various job descriptions and duties.

A couple of examples might help clear this up:

1. John is employed during the day on an assembly line at Company A. At night, he works on the assembly line at Company B. If he was injured on the job at Company A and was forced to miss work at both jobs, the wages for both jobs would be used to calculate his weekly benefit.
2. John works on the assembly line at Company A during the day. At night, however, he works in a non-physical supervisory job at Company B. If he was injured at Company A, his wages from Company B would not be used to calculate his weekly benefit. Moreover, he could continue working his job at Company B without it affecting his receipt of weekly benefits from Company A.

As you might imagine, there are many different facts that can potentially affect how your compensation rate is calculated and when it can be altered or suspended. If you were working multiple jobs at the time of a work accident, it would be prudent to contact a workers' compensation attorney to ensure that your weekly benefits are being properly calculated. Even if you're not in the Athens, Georgia area, we will gladly assist you in any way we can with respect to your workers' compensation case.

Quick Definitions: Panel of Physicians

The Panel of Physicians is a list of doctors and care providers which must be maintained and posted by the Employer in the event that a worker gets injured on the job. After an injury, a worker must treat with one of the physicians on the panel. In Georgia, there are three kinds of panels that may be utilized by an Employer: Traditional, Conformed, or MCO. 

For more information on the Panel of Physicians, please look here. 

Did You Know? (Termination From Employment Edition)

Did you know that if your Employer terminates you from your job because of your work injury, you are automatically entitled to the commencement of TTD benefits?

The question of whether the termination was actually due to the work injury is often a blurry one, because Employers will usually not document that the injury was the reason for the termination. Moreover, it is highly unlikely that an Employer will automatically begin paying workers' comp benefits to an employee they just terminated. 

Tip: If you have sustained a work accident and were later fired, it is highly advisable to contact an attorney to advocate for your rights. Even if the termination from employment was a part of a general lay-off (and was not related to the work injury), you may be entitled to receive TTD benefits if you are unable to find new employment because of your physical restrictions.

I injured my back at work and began receiving benefits. The next month, I injured my back again when I was playing basketball at home. Can the Employer suspend my benefits?

This is a very tricky question and there isn't a very clear cut answer. Chances are, you will be able to continue receiving workers' comp benefits for your back. However, the Employer will likely put up a pretty big fight against it.

Georgia law addresses what are commonly referred to as "independent intervening injuries" in O.C.G.A. 34-9-204(a), which states "No compensation shall be payable for the death or disability of an employee if his or her death is caused by or, insofar as his or her disability, may be aggravated, caused, or continued by a subsequent nonwork related injury which breaks the chain of causation between the compensable injury and the employee's disability."

The case law dealing with this issue in Georgia has been somewhat back and forth, but it appears as though the common theme is that Claimants who are actively receiving benefits/ongoing treatment for the initial work injury will be able to continue receiving the benefits, even if they are subsequently injured in a non-work accident (even if the Claimant was being careless or negligent). However, if a Claimant had been deemed to have fully recovered by his ATP and at some later point re-injures the same body part that was initially injured at work, a reinstatement of benefits would be denied.

Tip: It should be noted that the law requires the Employer to prove that the "chain of causation" has been broken, as opposed to simply unilaterally suspending benefits. In other words, in the example question used in the title of this post, the Employer would have to request an official hearing and have a judge rule on the matter before suspending benefits. If your Employer has cut your benefits off based on this contention, you should absolutely contact an attorney to discuss your options.

Again, this is a highly complicated area of workers' compensation law, so it is always best to consult with an attorney to determine how best to proceed. Even if you're not in the Athens, Georgia area, please contact us and we will do everything we can to fight for your rights.

Quick Definitions: Compensable Injury

This term is used to describe worker's compensation injuries and basically means "covered by workers' compensation insurance." A compensable injury is one that arose "out of and in the course of the Claimant's employment" and for which a Claimant can receive medical care and potentially income benefits.

If I suffer a heart attack or stroke while at work, is that covered by workers' comp?

Generally, no--but there may be situations where this type of injury is compensable. Georgia law specifically provides that an injury or personal injury does not include "heart disease, heart attack, the failure or occlusion of any of the coronary blood vessels, stroke, or thrombosis unless it is shown by a preponderance of competent and credible evidence...that any of such conditions were attributable to the performance of the usual work of employment.”

The reason for the general rule against these kinds of "injuries" being compensable is the principle that, in order to be covered by workers' comp, an injury must arise both "out of and in the course of employment." Thus, a heart attack or stroke is only covered if it can be proven that the work environment or certain aspects of the job led to the "injury." This type of claim can become highly contested due to the fact that these injuries are so factually unique and can be caused by many different factors, such as job stress. 

These injuries can also lead to another complicated area of workers' compensation law--idiopathic injuries. That is, if the Claimant suffers a stroke and falls down and sustains other injuries. If you or a family member has suffered a heart attack or stroke at work, please contact us and we will do everything we can to guide you through the process.  

Quick Definitions: Idiopathic Fall

The term "idiopathic fall" typically comes up as a defense asserted by the Employer.  Strictly defined, idiopathic means "of unknown cause or origin." Thus, an idiopathic fall is a fall caused by an unknown source. Essentially, when this defense to a workers' comp claim is used by an Employer, they are saying that the reason that the Claimant fell down was due to a reason that had absolutely nothing to do with the Claimant's employment, such as an epileptic seizure. An idiopathic fall defense is extremely complicated and very factually dependent, so if your Employer is denying benefits based on this theory, it is highly advised that you contact an attorney to discuss your options and rights.

Quick Definitions: Independent Medical Evaluation (IME)

An Independent Medical Evaluation, or IME, is a one-time examination that can be requested by either the Employer/Insurer or the Claimant. An IME is simply a way to obtain additional evidence, or simply some evidence to support the position of either party in the workers' compensation claim. For instance, if the Claimant's authorized treating physician (ATP) gives the opinion that the Claimant's injured back is fully healed, a Claimant may want to obtain an IME to contradict the ATP's diagnosis. This evidence can come in extremely handy at a hearing or during settlement negotiations.

I disagree with my authorized physician's diagnosis. Can I get a second opinion?

If effect, yes. Under Georgia law, a Claimant is allowed to seek a second opinion with a physician of his or her choosing (in other words, it is not limited to a care provider listed on the panel of physicians) at the expense of the Employer so long as several criteria are met. This one-time second opinion is known as an Independent Medical Evaluation (IME). Again, this is a one-time evaluation--not a change in the authorized physician. Unless you seek an official change of physicians, you will continue treating with your authorized treating physician (ATP) after the IME. 

The criteria are spelled out in O.C.G.A. 34-9-202(e):

1. The injury at issue must be an "accepted compensable injury." Basically, this means that the Employer must not be disputing that the injury is covered by workers' compensation coverage.
2. The examination is being sought within 120 days of the receipt of any income benefits (either TTD, TPD, or PPD benefits).
3. The examination must take place at a reasonable time and place, within Georgia or within 50 miles of the Claimant's residence.
4. The examination must be performed by a duly qualified physician or surgeon.
5. The Claimant must give advance notice, in writing, to the Employer of the examination.
6. The examination cannot repeat any diagnostic procedures that have already been performed on the Claimant since the injury, unless the costs of the procedures which are in excess of $250.00 are paid for by a party other than the Employer or Insurer.

An IME can be an extremely valuable tool for a Claimant when negotiating a settlement. Because a Claimant only has the ability to obtain one IME, it is imperative that great care be taken when choosing the IME physician. If you are dissatisfied with the care you are receiving from your treating physician, please contact us to discuss your options.