Source: http://workerscompanswers.blogspot.com/
Timestamp: 2019-04-24 19:50:08+00:00

Document:
This morning, the Georgia Court of Appeals issued a decision in the case of Garcia Trucking v. Jose Sandoval. While there is no new standard announced in this decision, there are some practical lessons to be drawn from it, most especially in light of the changes to the Board Rules regarding filing of the WC-1 and decisions regarding whether to accept or controvert your cases. First, the decision: Sandoval reported an injury that occurred in October 2014. There is a dispute as to when an injury was reported but the employer knew or had reason to suspect and investigate a possible injury given that Sandoval was at the time missing work. There was dispute as to whether Sandoval had a pre-existing lower back problem and received some degree of medical care for that condition prior to the injury. At trial the ALJ found the claim to be compensable. The claimant was awarded assessed attorney fees against the employer for unreasonable defense of the claim. The First Report of Injury denying the claim was filed more than 21 days from the notice of injury and so penalties were assessed for that failure but attorney fees were not awarded for the late filing of the WC1. On appeal the Appellate Division of the State Board of Worker’s Compensation pointed to the factual disputes and the closely contested issued in its decision to uphold the filing of compensability but to reverse the award of assessed fees. Sandoval appealed to the Superior Court seeking to have the assessed fees reinstated. The Superior Court obliged, citing an error of law in which the State Board’s failure to cite evidence about the late filing of the WC1. The Superior Court reasoned that failing to cite evidence meant that there was no evidence and so the Superior Court was not bound by the “any evidence” standard of review. The Court of Appeals reversed the Superior Court , reinstating the award of the State Board and denying Sandoval’s request for assessed fees. The Court noted that the ALJ assessed fees for unreasonable defense and not for the late filing of the WC1 so when the Appellate Division of the State Board found the defense to have been reasonable, the ALJ’s award, at least as to attorney fees, was reversed. In other words, there WERE facts in evidence upon which the Board based its findings to deny the assessment of fees. The Court made special notice that the assessed fees were NOT based on the late filing of the First Report of Injury. Second, practice pointers from the decision: 1) Factual determinations are initially made by the ALJ but can be accepted or rejected by the State Board’s Appellate Division. If you don’t get the facts in your favor before you get to the Superior Court you need an error of law to change the decision. As a practical matter, this means that most Superior Court appeals are going to be bound by the any evidence rule. 2) If the Superior Court reverses a decision, chances are that the Court of Appeals will accept the Application for Discretionary review if there is evidence to support the award of the State Board. 3) You and your Counsel must know the difference between a factual issue (disagreeing with HOW the Judges viewed the evidence) and a legal issue (failure to apply the correct standard) 4) Recent changes in the Requirements for filing the WC1 and in the necessity to make a decision on accepting the claim can serve as an independent basis for an assessment of attorney fees and will be used by Counsel for the Injured worker any time that it is applicable. a. File the WC1 within 21 days of the notice of injury. For Employers this means reporting the injury to your carrier as soon as is possible and working diligently to assist in the investigation b. If you are uncertain as to whether the claim is or should be compensable, mark the WC1 as medical only, file it within 21 days from notice of the injury and provide authorized care while the investigation is ongoing c. If you decide later that the claim should not be compensable, file a WC3 to controvert. Call on us if we can be of assistance.
Last week we provided to you a summary of legislation pending before the Georgia General Assembly pertaining to worker’s compensation in Georgia. That legislation is now one step closer to being law as it has passed the Georgia State Senate this afternoon and is now headed to the Georgia House of Representatives for consideration. As mentioned the legislation raises the maximum TTD rate to $675.00 per week, the Max TPD rate to $450.00 per week and the Death Benefit to $270,000.00. The most consequential change, however, is that relating to the 400 week cap on medical benefits. While the 400 week cap still applies, the legislation does carve out an exception for Durable Medical Equipment, joint replacements, etc. The wording of the statute, inserting a new provision specifically covering all injuries on or after July 1, 2013, would mean that the expansion of medical entitlement for these precise categories would operate retroactively. If, therefore, you have cases that would be affected by this legislation, you might wish to conclude them by stipulated settlement now. The average claim, will not, however be affected. Also of interest is House Bill 474 which would provide limits and administrative requirements on the Rulemaking powers of the SBWC. Currently O.C.G.A. §34-9-60 provides the statutory authority for the State Board of Worker’s Compensation to promulgate rules as to HOW the Board will operate and what is to be done pursuant to the Statutes. That rulemaking authority must be carried out consistent with the Statute or the rule is subject to challenge. In other words, the Statute controls. House Bill 474, similar to an effort passed by the legislature last year but vetoed by then-Governor Deal, would have made the Board subject to the Administrative Procedures Act. This effort would require publication of proposed rule, public comment and then review of the rule by legislative committees BEFORE any such rule could take effect. This is simply new packaging to last year’s rejected solution and is not likely to be passed. Instead, House Bill 474 is being sent to the Advisory Committee for comment. The entire purpose of the Advisory Committee structure is to assure that the Georgia Workers’ Compensation System being run by consultation and consensus. House Bill 474 would seem to be an effort to require advice and comment when such has already been given by the very parties who know what proposed changes would do to the system. We will let you know what becomes of this bill in the future. We do not expect it to be passed this year.
It often seems like the Courts speak through an inexpert interpreter. Part of the problem is that we look for the result of the case and not to how the Court got to that result. The other problem comes from the attempt of the Court to reconcile different lines of authority that have developed over time, especially when that authority involves other principles of law. This morning, February 26, 2019, the Georgia Court of Appeals issued a decision in Daniel v. Bremen-Bowdon Investment Co.,. This case, and the case upon which it relies may prove to have far-reaching effects on Georgia Worker’s Compensation. Ms. Daniel was employed as a seamstress and was taking a scheduled lunchbreak. During that break she was permitted to leave the premises and do whatever she pleased with her time. She intended to go home for lunch but on the way to the parking lot, was injured. The problem for her was that to get from her work station to the parking lot, she had to cross a public street and traverse a sidewalk. In order for an injury to be compensable, it must 1) Occur in the Course of the Employment and 2) Arise out of that employment. For an injury to be IN THE COURSE of the employment, the employee must be WHERE they are supposed to be WHEN they are supposed to be there. So that one looks to the TIME and PLACE that an injury happens. This usually means that an employee injured while going to and from work is not IN THE COURSE of his employment. For an injury to ARISE OUT OF the employment, the Employee must be doing something in furtherance of the employer’s business. This is a causal connection between the employment and the injury. An injured worker must prove both IN THE COURSE OF and ARISING OUT OF in order for her injury to be compensable. Exceptions/clarifications to these rules have developed over time. This is where the different lines of authority problem comes into play. The Scheduled Rest Break Defense asserted by the Employer to the Compensability of an injury is meant to recognize that the Employer does not have control over the Employee during the scheduled break and so injuries occurring during such a scheduled break are not compensable. However, historically, the employee’s injury might still be compensable if the injury occurred during a “reasonable time for ingress and egress” to the employment premises. That changed in November 2018, when the full court of the Georgia Court of Appeals decided Frett v. State Farm Employee Workers’ Compensation. Ms. Frett was also on a scheduled break but was injured while in an employee break room on the employer’s premises when she was injured. That Court declined to graft onto the “Scheduled Rest Break Exception” the “Ingress and Egress” Doctrine. In other words, while the Scheduled Rest Break would have meant the injury was NOT compensable, the Ingress and Egress Doctrine would have meant that the case WAS compensable. The Frett Court declined to apply the exception to the exception as it felt that they lacked the authority to do so. Ms. Frett’s injury was deemed not to have arisen out of her employment. “In our view, any decision to apply the ingress and egress rule to the scheduled break exception should be made by our Supreme Court, particularly because the Supreme Court has never expressed its view on the ingress and egress rule generally.” So, while ruling against Ms. Frett, the Court invited the Supreme Court to take a look. That brings us back to Daniels v. Bremen-Bowdon. The Daniels court noted the Court’s disapproval of the previous authority in Frett v. State Farm and decided that the Ingress and Egress Rule does not apply to the Scheduled Rest Break scenario. Judge Goss, who joined the Majority opinion in Frett, wrote the opinion in Daniels and was joined by Judge Brown who did not participate in Frett. Given the rules of the Court of Appeals, the Daniels decision is known as “physical precedent” (binding fo r this case) but is not “Binding precedent” (good authority on which future litigants must rely). All of this is a confusing way of saying that changes may be afoot. First, in both Frett and Daniels the ALJ initially found the claims to be compensable. In both cases, the Appellate Division of the SBWC found the cases to be NOT compensable in both cases on the interplay between the scheduled rest break and the ingress and egress doctrine. The Court of Appeals, accepting the factual determinations made by the SBWC looked to potential legal error in the refusal of the SBWC to apply the Ingress and Egress rule at a time when the Employee was free to do whatever the employee wanted on a scheduled break. The Court of Appeals, generally bound by the “any evidence rule” is accepting the SBWC decisions to the extent that they do not clearly contradict established caselaw. Neither the Georgia Supreme Court nor the Georgia General Assembly have made their views known. Even Judge Yvette Miller, formerly an ALJ for the SBWC, is asking for the Supreme Court to step in. She wrote, in her dissenting opinion in Frett : “But I certainly agree with the majority that the conflicts between the two lines of cases cannot continue, particularly because injuries implicating both the scheduled break rule and the ingress/egress rule arise far too often. And as a former director and appellate judge of the Board, I am acutely aware of the need for employers and employees—as well as the Workers' Compensation bar—to have clear direction in the law. “ As this decision shakes out and the full contours of the developing authority become known, we will keep you updated.
So...Can We Drug Test or Not?
Post accident drug testing has been a valuable tool in the toolbox for employers wishing to promote a safe work environment. Such testing has also provided a solid defense to otherwise compensable claims if the employer could establish the presence of drugs in bodily fluid samples obtained within a certain period of time after the injury occurs. Some states such as Georgia even provide for premium discounts if the Employer qualifies as a Drug Free Workplace. So, when The US Department of Labor published a rule entitled “Improve Tracking of Workplace Injuries and Illnesses – Employee's right to report injuries and illnesses free from retaliation” many employers began to question whether an employer could safely continue their Drug Free Workplace Program. or use post-accident Drug Testing. The chilling effect of the proposed rule was real even if the response was an overreaction. Indeed, even under the tighter rule issued in October 2016 before the end of the previous administration, the guidance offered by OSHA provided: The rule does not prohibit drug testing of employees, including drug testing pursuant to the Department of Transportation rules or any other federal or state law. It only prohibits employers from using drug testing, or the threat of drug testing, to retaliate against an employee for reporting an injury or illness. Employers may conduct post-incident drug testing pursuant to a state or federal law, including Workers' Compensation Drug Free Workplace policies, because section 1904.35(b)(1)(iv) does not apply to drug testing under state workers' compensation law or other state or federal law. Random drug testing and pre-employment drug testing are also not subject to section 1904.35(b)(1)(iv). Employers may conduct post-incident drug testing if there is a reasonable possibility that employee drug use could have contributed to the reported injury or illness. Still many abandoned post accident drug testing completely, lest in practice they venture too close to the line and be accused of retaliation. Last week, on October 11, 2018, the previous rule was rescinded and a new rule published in its place. That new rule can be found here: https://www.osha.gov/laws-regs/standardinterpretations/2018-10-11 . This clarification emphatically states: “To the extent any other OSHA interpretive documents could be construed as inconsistent with the interpretive position articulated here, this memorandum supersedes them.” As if to emphasize the point, the “clarification” reads: The purpose of this memorandum is to clarify the Department’s position that 29 C.F.R. § 1904.35(b)(1)(iv) does not prohibit workplace safety incentive programs or post-incident drug testing. The Department believes that many employers who implement safety incentive programs and/or conduct post-incident drug testing do so to promote workplace safety and health. In addition, evidence that the employer consistently enforces legitimate work rules (whether or not an injury or illness is reported) would demonstrate that the employer is serious about creating a culture of safety, not just the appearance of reducing rates. You can see from the language used that while drug testing is explicitly permitted, that employers would still be well advised to use such testing not solely for the purpose of reducing rates but also to promote a safe work environment without dissuading employees from reporting injuries. In this respect, the language of the clarification is quite similar to the language of the rule published at the end of the prior Administration. What is really new in the “clarification” is additional suggestions or guidance which encourages employers to take positive steps to great a workplace culture that emphasizes safety and not just rates. Some options: • an incentive program that rewards employees for identifying unsafe conditions in the workplace; • a training program for all employees to reinforce reporting rights and responsibilities and emphasizes the employer’s non-retaliation policy; • a mechanism for accurately evaluating employees’ willingness to report injuries and illnesses. One of the more practical suggestions for a permissible drug testing regime is that Drug testing used “to evaluate the root cause of a workplace incident that harmed or could have harmed employees. If the employer chooses to use drug testing to investigate the incident, the employer should test all employees whose conduct could have contributed to the incident, not just employees who reported injuries.” Much of the current guidance seems to be common sense. Don’t use Drug Testing as retaliation for reporting an injury. Don’t drug test if the injury is not plausibly related to intoxication or impairment. For example, could Carpal Tunnel Syndrome have any conceivable connection to alcohol or illicit drug usage? The bottom line is, get the specimen cups ready. Testing is back on the table. If we can help you with your drug-testing or Worker’s Compensation questions, please do not hesitate to contact us.

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