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Court Finds Employee’s Surgery Caused by Preexisting Condition and Not Entitled to Compensation

On Behalf of | Jan 4, 2018 | Workers' Compensation Case Law |

In some Georgia workers’ compensation cases, disputes arise not over the accident itself but over which treatments are covered under workers’ compensation benefits. In one recent case, the employer disputed whether a knee replacement surgery two years after the work injury was required because of the work injury or because of a preexisting condition.

In that case, after an electrician slipped on the step of a truck at work, his employer accepted that the injury to his knee was compensable for workers’ compensation benefits and authorized treatment with an orthopedic surgeon. The same surgeon had seen the employee about two years before the work injury and noted significant pain, which suggested either arthritis or a preexisting tear, but he did not find a need for treatment at the time. After the work injury, the surgeon found significant preexisting left knee arthritis. The employee had more pain behind his left kneecap and suggested a tear in his medial meniscus. The surgeon recommended left knee surgical repair, and the employer authorized the repair.

About two years after the work injury, and after the surgeon had operated on the employee, the surgeon diagnosed the employee with osteoarthritis of his left knee and a left knee medial meniscus tear, recommending a left total knee replacement. He later testified that the employee’s preexisting condition was the major contributing cause of the need for the knee replacement. The employee requested authorization for the knee replacement, but the employer asserted that it was not compensable. The employer argued that the employee’s arthritis was a preexisting condition and that the knee replacement was required because of the condition, and the work injury was not the major contributing cause of the knee replacement.

The appellate court found that the employee’s arthritis was a preexisting condition. In addition, based on the surgeon’s opinion, the total knee replacement was required primarily because of the preexisting arthritis, and therefore, the surgery was not compensable.

Disputes Over Medical Treatment

Under O.C.G.A. 34-9-200, an employer is obligated to provide and pay for medical treatment related to a covered injury. This generally includes medical treatment provided by the authorized treating physician. However, some cases may require pre-authorization for certain tests or treatments, which may be disputed by the employer. An employer may argue that the tests or treatments are not related to the work injury or that they are not reasonably required or likely to cure or relieve the condition or to restore the employee to suitable employment.

Have You Been Injured at Work?

If you or a loved one has been injured in a Georgia workplace accident, do not let the employer prevent you from obtaining the compensation you deserve. Even if the employer denies authorization of certain tests or treatments, a court may find that you are entitled to those benefits. At the law office of J. Franklin Burns, P.C., we have a track record of positive case outcomes resulting in millions of dollars in compensation. Call us at 404-920-4708 or fill out the contact form on our website to set up a free consultation.