Georgia workers’ compensation law says that your work injury will trigger workers’ comp. benefits if it arose out of and in the course of your employment. Your injury must meet both of these conditions to be compensable as a workers compensation injury.
“In the course of employment” generally means that your injury occurred while you were on the clock, and not on break or engaged in horseplay.
“Arising out of” your employment means that there must be some connection between your work activity and your injury. If, for example, you performing your regular job duties and you suddenly have a heart attack or a stroke, your employer will not be required to pay for your medical care or provide your temporary total disability benefits because it is assumed that your underlying heart condition or vascular problem was not related to your job duties. You can recover benefits if you can prove that your heart attack, stroke or other long standing medical problem was caused by conditions at work. For example, if you are exposed to a chemical at work that triggered a heart attack, or a fall or some other injury, your injuries would be compensable.
Generally, however you can expect pushback from your employer and their insurance company if you experience an injury that most likely has underlying causes other than your work activity. A medical problem that has minimal relation to your performance of job duties, which arose from an unknown cause is called an idiopathic injury.
Idiopathic injuries that do not arise out of your employment are not compensable under Georgia workers compensation law, so this issue often results in litigation. Several idiopathic injury cases have reached appellate courts in Georgia, although the law in this area is still evolving. These appeals cases are helpful to better understand where workers’ compensation judges are supposed to draw the lines between a non-compensable idiopathic injury and a compensable work injury.
in the case of Harris v. Peach County, a custodian bent over to pick a pill off the floor and dislocated her knee because of her excessive body weight. The Georgia Court of Appeals held that Ms. Harris’ injury was compensable because she was engaged in an activity related to her job duties. While Ms. Harris’ body weight was no doubt the main factor causing her injury, the appeals court found her injury compensable because she was performing a job duty when her knee buckled.
Presumably Ms. Harris’s injury would not have been considered a work injury arising out of employment if her knee had buckled while she was walking down a hallway and not engaged in any specific activity.
In the case of Davis v. Houston General Insurance Company, however, the Georgia Court of Appeals reached a different conclusion. In the Davis case, Ms. Davis, a nurses aide, injured her back while she was putting on her coat, getting ready to leave work for the day. The Court noted that the risk of back injury was not in any way related to the claimant’s job duties. Putting on a coat is not a work function and thus the relationship to the Ms. Davis’ job was too tenuous.
Would the court have reached a different conclusion if Ms. Davis was putting on a “HazMat” suit to clean up dangerous chemicals? I would argue that putting on a HazMat suit is causally related to one’s employment whereas putting on an overcoat to go home is not. I hope you can see that the question of whether a work injury is causally related to a particular job requires a case by case analysis and can involve some very careful line drawing.
What Should You do if the Insurance Company Suggests that Your Claim Should be Denied as an Idiopathic Injury?
If you sense that the insurance company intends to deny your claim on the grounds that your injury has nothing to do with your job duties, you should avoid speaking directly to the insurance adjuster or anyone involved in the handling of your claim. The words you use in describing what happened and how you felt at the time of your accident can be used against you, thus, I would recommend that you speak to a lawyer like me as early in your case as possible.
When you are put on the spot to “explain what happened” you may say something that sounds normal in conversation but could be used against you in your workers’ compensation claim. If you have any questions about idiopathic injuries or any other Georgia workers compensation issue, please call me at 770-351-0801 or email me by clicking on the link.