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Dallas Nt’l Ins. co. v. De La Cruz – Fighting for Permanent Total Disability

On Behalf of | Sep 8, 2015 | Georgia Workers' Compensation |

When a work-related injury prevents you from being able to work, you may be qualified for workers’ compensation.

However, deciding how much you receive and for how long is a complex process. There are many different types of “disability” under Georgia workers’ compensation law. Those include:

  • Temporary Total Disability
  • Temporary Partial Disability
  • Permanent Partial Disability
  • Permanent Total Disability
  • Death Benefits

Each has a different proof burden that must be met, though there is often discretion granted to doctors, the state commission and the courts in deciding which category best describes your circumstances.

The recent case of Dallas Nat’l Ins. Co. v. De La Cruz , before the Texas Supreme Court, dealt with the issue of permanent total disability.

Permanent total disability is essentially the result of a catastrophic injury. It means that according to your doctor, you are completely disabled and cannot work in any capacity. For this, you are paid two-thirds of your previous wages until your condition improves.  In the event your injury involves something like severe brain damage, quadriplegia or paralysis, you may also be entitled to receive rehabilitation benefits.

But the system is not inclined to award such benefits on the word of a single doctor. It typically takes a fair amount of work to build a case to make this assertion, especially if the injury was not catastrophic.

In the De La Cruz case, justices determined the claim failed because plaintiff did not make an adequate causal connection to the compensable injury and her permanent disability.

According to court records, plaintiff was a cook at a restaurant in Texas when she fell, suffering injury to her knee and back. The company carried workers’ compensation insurance (Texas is the only state that doesn’t require companies to do so, but this one did). There was no dispute her injuries were compensable.

The month after the fall, she was released to work light duty. However, she couldn’t perform even these light duties, and so her doctors again took her off work.

Eventually, she had to undergo back surgery and knee surgery. In spite of this, plaintiff continued to suffer pain and numbness in her legs and back and continued to receive treatment.

Five years after the fall, she claimed her injury had caused the total loss of use of both feet. She asserted this loss was permanent, and as such, she was entitled to receive permanent total disability.

Under Texas state law, had she been able to prove her claim, she would have been awarded benefits. In fact, the trial court DID award her benefits, and the appeals court affirmed. However, the state supreme court reversed.

The court noted that in order for loss of use of a member (i.e., a foot, a leg, a hand, etc.) to be compensable, one has to show the loss of use resulted from injury to the member itself, rather than loss of use resulting form injury to another body part. Further, pain alone is not an injury under the act because it isn’t “damage or harm to the physical structure of the body.”

Here, the court found plaintiff’s record of proof lacking when this standard was applied, and thus reversed the lower courts, denying her permanent total disability benefits.

If you have questions about permanent total disability benefits in Georgia, we can help.

For information on Atlanta work injury compensation, contact J. Franklin Burns, P.C., at 1-404-920-4708 .