Atlanta Personal Injury Lawyer Blog

Worker's Compensation attorneys for The Griffin Law Firm win a catastrophic designation for their client:
In the realm of worker's compensation, there are many talented worker's compensation attorneys on both sides of the fence (claimant's attorney and defense attorney). This means that legal battles occur in which the value of the worker's compensation claim can either be greatly increased or greatly decreased based on the worker's compensation judge's ruling on the issues at a worker's compensation hearing. One such battle occurred when the experienced worker's compensation lawyers at The Griffin Law Firm, P.C. successfully won a catastrophic designation for one of their worker's compensation claimants. Absent a strong worker's compensation lawyer, this claimant would have had their temporary total disability income benefits (weekly payments for lost wages) stopped prior to or at the end of the 400 week period from the date of the accident. Under O.C.G.A. Section 34-9-261, a claimant is only eligible for temporary total disability benefits for a maximum of 400 weeks from the date of the on the job accident. However, since the hearing was won, the worker's compensation claimant for our firm will now be eligible to receive temporary total disability income benefits for life unless he recovers from his catastrophic injuries and is able to return to the work force.

What is a catastrophic worker's compensation claim?
Under O.C.G.A. Section 34-9-200.1(g) a claim is catastrophic under the following circumstances:
(1) Spinal cord injuries;
(2) Amputation;
(3) Severe brain or closed head injuries;
(4) Second or third degree burns over 25 percent of the body as a whole or more of the face and hands;
(5) total or industrial blindness.
(6) Catch-all Clause: Additionally, the statute provides a “catch all” definition for certain cases that do not fall into the specific categories. Since July 1, 2005, “catch all” is defined as any other injury of a nature and severity that prevents the employee from being able to perform his or her prior work and any work available in substantial numbers within the national economy for which the employee is otherwise qualified. In addition, if the authorized treating physician has released the employee to return to work with restrictions, there shall be a rebuttable presumption during a period not to exceed 130 weeks from the date of injury, that the injury is not a catastrophic injury.

What are the facts surrounding the particular worker's compensation claim that was awarded a catastrophic designation?
On August 28, 2005, while unloading boxes from a pallet, the employee injured his left knee. Subsequent to the employee’s accident and injure, the Employer-Insurer accepted the employee’s claim as compensable, by paying the employee income benefits and providing the employee with medical treatment.

The employee underwent surgery on his left knee and when he did not improve he underwent partial left knee replacement surgery. Due to overcompensating for his weakened left knee, the employee developed right knee pain. The Employer-Insurer accepted the right knee as a compensable “super-added” injury. Eventually, employee received total right knee replacement surgery.

The employee began a pain management regimen with an additional physician. The Employer-Insurer had the employee undergo a Functional Capacity Evaluation (“FCE”) to determine the employee’s ability to perform work suitable to the employee’s physical limitations. The FCE resulted in a recommendation that the employee would be safe working in a Light physical demand level but should limit material handling on level terrain only, no incline, no dirt and no gravel; a walking tolerance of 10 continuous minutes and to avoid squatting, kneeling, balancing, and ladder climbing activities.

The surgeon agreed with the FCE findings and provided impairment ratings of 37% left lower extremity and 55% right lower extremity and placed the employee on light duty restrictions in accordance with the FCE findings. The employee continued to see the pain management doctor and the surgeon discharged the employee from further treatment as it was the surgeon’s opinion that there was nothing further that could be done orthopedically. Attempts by the employee and Employer-Insurer to agree on a new orthopedic physician failed because each potential doctor agreed with the surgeon that nothing further could be offered. The employee continued to suffer pain in his legs and knees and also in his low back. The pain management physician believed that employee’s work restrictions should be at the Sedentary physical demand level.

Based upon the surgeon and pain management physician’s work restrictions we advised our client to seek catastrophic designation under O.C.G.A. § 34-9-200.1(g)(6). Generally, if a doctor continues to keep an injured worker completely out of work or if there is no light duty job available, an injured worker is entitled to a maximum of 400 weeks of indemnity (weekly check) benefits. The Employer-Insurer can further decrease their exposure to pay such indemnity benefits by serving a WC-104 upon the injured worker that has attached to it the authorized treating physician’s light duty work restrictions. However, the cap on indemnity benefits can be eliminated if the injured worker’s condition is deemed catastrophic by the Workers’ Compensation Board.

Prior to filing a WC-R1CATEE with the Board we attempted to negotiate with the Employer-Insurer into accepting the case as catastrophic and/or settling the case. The Employer-Insurer responded and maintained the same stance throughout the litigation that they were not interested in settlement or mediation and would defend the case before the administrative law judge (“ALJ”) assigned to the case. We filed the WC-R1CATEE with the Board and the Employer-Insurer filed an objection and requested an evidentiary hearing.
During the litigation, the parties served discovery requests upon each other. The employee answered within the time set by law and later supplemented the response with the identification of employee’s expert witness. The Employer-Insurer deposed our expert witness, a vocational rehabilitation counselor recommended by the Griffin Law Firm, but would not agree to let the employee use the deposition transcript in lieu of the expert’s live testimony at trial. This added further expense to the employee’s case. The Employer-Insurer was served with employee’s discovery requests. After the time had passed for the Employer-Insurer to provide a response, we provided the Employer-Insurer with another courtesy copy of the requests and asked when a response would be due. Six days before trial, Employer-Insurer provided to employee their expert witness’s report, which showed that the Employer-Insurer had been in possession of the report for several weeks.
In addition to the Employer-Insurer’s discovery tactics, the Employer-Insurer unilaterally and without notice to the employee reduced his weekly indemnity check by $150.00 from $450.00 to $300.00 per week. Despite being unfairly disadvantaged by the Employer-Insurer’s discovery tactics, we pressed ahead with the presentation of evidence at the hearing before the ALJ.

The employee testified to his previous self-employment and management history that the Employer-Insurer argued showed that the employee possessed considerable skills that translated into there being substantial jobs available in the economy. The ALJ found the employee’s expert witness’s testimony more persuasive than the Employer-Insurer’s expert witness. This testimony, along with pertinent medical statements that we procured from the treating doctors resulted in the ALJ awarding catastrophic designation and reinstating the weekly benefits to the previous $450.00 level.

We have found that it is often not enough to simply supply all of the medical records to the court because doctors frequently do not provide the terminology necessary for the ALJ to reach an easy decision. The Griffin Law Firm has the resources and experience to obtain from physicians the facts and opinions that strengthen the injured workers’ case.

Why is it critical to hire a worker's compensation lawyer?
If you have a serious worker's compensation injury that will likely keep you out of work for a long period of time, then you definitely need a good worker's compensation lawyer on your side. It is not a matter of if you will need the attorney, but rather when because at some point whether you realize it or not, having an attorney is the only way to make sure you are fully compensated for your worker's compensation claim.