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Causation in Georgia Workers’ Compensation Cases

Workers’ compensation benefits include medical coverage for workers who’ve sustained a workplace injury or illness. In order for the employer’s workers’ compensation insurance to cover the injured worker’s medical expenses and pay disability benefits, the injury must be the result of a work accident or related to work. Establishing causation in Georgia workers’ compensation cases is, therefore, a key to recovering benefits.

Will workers’ compensation cover my treatment and pay me disability benefits?

Any treatment you receive or test that you are subject to that is required because of your work injury or illness is compensable under your employer’s workers’ compensation insurance. If your authorized physician determines or you otherwise prove that your condition is related to your job, then this satisfies the causation element and your employer’s insurer will cover your expenses and provide disability benefits.

 Arguments Employers Might Make

Some employers/insurers might argue that your injury is not related to work at all and therefore deny your workers’ compensation claim. Below are examples of unique types of cases which employers often dispute:

  • Cumulative/repetitive trauma injuries – The insurer might argue that the injury did not arise out of a single event. However, this is an invalid defense because the injury does not have to be from a single event or accident; it can be cumulative trauma or a repetitive motion injury. Examples of workers at risk for these injures are factory workers, line workers, computer/desk jobs, cashiers at grocery stores, etc.
  • Pre-existing, congenital, or degenerative condition – The insurer may try to argue otherwise, but the presence of one of these types of conditions does not automatically discredit a claim. Aggravation of a pre-existing injury or aggravation of a degenerative condition can still qualify for workers’ compensation benefits.
  • Overuse injury – Overuse injuries, officially referred to as “superadded injuries,” may arise if a worker must overcompensate for another injury suffered at work. For example, a worker with a right shoulder injury who returns to work may exclusively use his left arm. He may suffer an injury to his left arm because of the overuse. Both the right and left shoulder injuries would be covered because they are related to work.

Authorized Diagnostic Testing is Covered

However, an issue seems to arise in many workers’ compensation cases in which the compensability of diagnostic testing isn’t clear. Sometimes, the authorized physician has to order diagnostic testing to determine if the claimant’s condition is either directly or indirectly related to work or if it’s completely unrelated. For example, if a patient comes in with back pain, the doctor may have to run tests to determine if the pain is from a muscular work-related issue, or from a non-work-related bladder infection.

If the back pain is muscular in nature and caused by work conditions, then the diagnostic testing and the necessary treatment are covered under workers’ compensation. Conversely, if the test shows that a bladder infection is causing the pain and therefore unrelated to work, then the treatment will not be compensable under worker’ compensation.

Interestingly though, Atlanta courts hold that even if the condition isn’t work-related and the treatment isn’t compensable under workers’ compensation, the Court can still order the employer to foot the bill for the diagnostic testing. Any authorized tests, assessments, and evaluations administered to an employee to determine causation of the injury are generally to be paid by the workers’ compensation insurer.

Determining Who Should Pay Your Medical Expenses

If you are suffering from an injury or illness that you believe is work-related, consider having your case evaluated by a workers’ compensation lawyer to determine to what types of benefits you might be entitled. If you have undergone medical tests to determine if the cause of your condition was related to work, then you should not have to pay the bill for those diagnostics.

Discuss your case with Bader Scott Injury Lawyers. Contact us today at 678-562-5595 for a free consultation.

Seth Bader
(678) 562-5595