Georgia workers’ compensation law covers aggravations of preexisting conditions as work injuries. These injuries are covered until the aggravation injury “resolves”. A 2015 Georgia Court of Appeals decision in the case of Emory University v. Duval shows how different medical opinions are used to reach decisions using this part of the law.
The facts behind the Court of Appeal’s decision
Ms. Duval injured her right shoulder at work in 2010. She got some medical treatment. She then ended up having surgery on her left shoulder. When she later tried to get more medical treatment for her right shoulder, the insurance company refused to pay for it.
After a court hearing was held, the administrative law judge determined that Ms. Duval could get more medical treatment on her right shoulder based on the opinion of her treating physician. However, when the case was appealed, that decision was reversed because the Appellate Division of the State Board of Workers’ Compensation believed the doctor to whom the insurance company sent Ms. Duval. That doctor (who happened to also work for Ms. Duval’s employer) said that the aggravation injury to Ms. Duval’s right shoulder had resolved and that her problems were from a preexisting condition. On appeal, the superior court reversed this decision. The case was then appealed to the Georgia Court of Appeals.
What did the Court of Appeals decide?
The Court of Appeals reversed the superior court’s decision based on a part of the law called the “any evidence” rule. This part of the law means that certain appeals courts do not really analyze the facts much; they just analyze the law and how it was applied. So, the injured worker lost the case.
The interesting part of the case is that it demonstrates a common fight in workers’ compensation cases. Insurance companies are often trying to say that something else caused the medical problems that you are having. They often try to blame it on a preexisting condition, a previous injury or old age. In this case, they were successful because the Appellate Division judges believed the doctor that Emory used.
Workers’ compensation cases that involve preexisting conditions are complicated. The insurance company tries to get off the hook by blaming your problems on some injury that happened years ago. However, if they can find a doctor who will support this argument, a judge can choose to believe that doctor. Because of that, it can be very important to make sure you have a good attorney to make sure you present the evidence necessary to win your case. If you would like to speak to one of our attorneys who specializes in workers’ compensation, simply call the phone number or fill out the “Need Help” form on the right side of this page for a free consultation.