Our Atlanta work injury lawyers expect employers to challenge workers’ compensation claims on the grounds that they weren’t actually caused by job duties. We also sometimes anticipate challenges to ongoing benefits, based on argument the underlying work injury has largely healed and other conditions have come into play.However, in the recent case of Hayes v. Rosenbaum Signs, the employer initially agreed to cover medical costs. But then the employer stopped. When the worker filed a petition, the employer conceded the worker’s job was a major contributing factor to his need for medical treatment. The case was dismissed. A year later, the employer again denied treatment, this time based on an evaluation by a new doctor indicating the original injury was likely not work-related.
Ultimately, the South Dakota Supreme Court was asked to weigh in the matter, and decide whether the employer was judicially estopped from taking this kind of inconsistent position.
Although it’s an out-of-state claim, the circumstances may be relevant to some of our clients here in Georgia.
In the Hayes case, the worker was employed at a sign company in March 2007 when he injured his back. Initially, the company and its insurer treated the claim as compensable, and it covered the worker’s cost for medical treatment.
However, the employer required the worker to see a certain doctor for an independent medical exam in October 2007. Based on this doctor’s findings, the employer refused to pay for further medical treatment.
The worker filed a petition in May 2009, alleging he was entitled to medical benefits via workers’ compensation for his injuries. The company denied the injuries were work-related. The worker submitted an affidavit from his treating physician, indicating the job had been a major contributing cause for the man’s current condition and need for ongoing medical care.
The original doctor was later deposed, and testified the worker’s injuries were only half caused by work; the other half could be attributed to a pre-existing lower back condition.
Later, however, the employer conceded the back injury was largely a result of work, and agreed to pay the man’s medical bills. The case was dismissed without prejudice.
In May 2011, the employer required the worker to see yet another “independent” doctor. This doctor indicated that while the worker had suffered an initial injury at work, it was no longer a major contributing cause of his condition. Rather, his ongoing treatments were related to a chronic back condition the man had suffered since the 1980s. The company again stopped paying the worker’s medical bills.
The man requested a hearing. He argued the employer was barred from changing its earlier position per the principle of res judicata, which basically means the same matter can’t be litigated twice. The employer argued res judicata was not applicable.
A state department overseeing workers’ compensation claims sided with the employer, and found the worker hadn’t met his burden of proof on causation. The circuit court affirmed, and the worker appealed to the state high court.
The South Dakota Supreme Court reversed. The court reasoned the later position taken by the employer was clearly inconsistent with the first, which had been judicially accepted and thus the risk of inconsistent legal determinations was raised. Additionally, the party taking the inconsistent position stood to derive an unfair advantage if not estopped. Therefore, the company was barred from taking further action disputing the source of the worker’s injury.
For information on Atlanta work injury compensation, contact J. Franklin Burns, P.C., at 1-404-303-7770.