The weekend is upon us! This week’s tip covers the impact of a Return to Baseline opinion in Georgia (it’s a homerun):
RULE
- O.G.G.A. 34-9-1(4) states “injury” and “personal injury” shall include the aggravation of a preexisting condition by accident arising out of and in the course of the employment, but only for so long as the aggravation of the preexisting condition continues to be the cause of the disability; the preexisting condition shall no longer meet this criteria when the aggravation ceases to be the cause of disability.”
- When an employee has a preexisting condition that limits his work capacity BEFORE the on-the-job injury, as soon as the effects of the on-the-job injury cease, the Employer’s responsibility for workers’ compensation also ceases. The employer is not responsible for compensating the employee until the preexisting condition improves as well or for showing that work exists suitable for an employee with a preexisting disability. Pearce v. AAA Cabinet Co., 173 Ga. App. 463 (1985).
RETURN TO BASELINE IS BETTER THAN A FULL DUTY RELEASE
- Once the Claimant “returns to baseline” or “returns to a condition that pre-existed the work injury,” the claim is outside the scope of O.C.G.A. 34-9-1 and they are thus no longer entitled to medical or indemnity benefits.
SCENARIO
- EX: Claimant aggravated his preexisting knee condition at work. The Employer/Insurer accept the claim as compensable, provide authorized medical treatment and commence indemnity benefits. Due to repeated missed appointments and “no-shows,” the Claimant goes without treatment for 3 months but continues to receive weekly TTD benefits. What should the adjuster do?
- Send a medical questionnaire to the authorized treating physician asking them to agree (1) “the Employer/Insurer has provided the necessary medical treatment such that the Claimant’s work injuries have resolved and returned to its pre-injury, baseline condition from before the accident, and any ongoing symptoms, disability, and need for treatment are no longer related to the work accident, (2) the Claimant is capable of working without restrictions, and (3) the Claimant has reached MMI with no permanent impairment.
I hope everyone has a great weekend. As always, feel free to reach out if you run into any GA questions/issues!
Sincerely,
John Fennelly | Junior Partner