According to Georgia Workers’ Compensation law, the aggravation of an old injury or pre-existing condition may be covered by workers’ comp insurance. Unfortunately, insurance adjusters often deny such claims reflexively and with little investigation. This is particularly true when the adjuster is located in a state other than Georgia where the law related to pre-existing injuries is different.
Because of this misunderstanding of Georgia law, insurance adjusters often issue quick and confident denials any time they can connect a work injury to a pre-existing condition or injury. This might include an old injury, prior surgery, arthritis, degenerative disc disease, or other conditions. If your workers’ comp claim has been denied (or you think it might be denied) for these or similar reasons keep reading. Your injury might be covered.
The Law Does Not Require You to Be Perfectly Healthy Before Your Work Injury
Many people assume workers’ compensation insurance only covers perfectly healthy workers with brand-new injuries. But the reality of life and work is that many people (maybe most people) do get injuries and develop health conditions over time. It’s normal. So, Georgia Workers’ Compensation law takes this practical truth into account.
Often the real legal question is whether your work activities aggravated, accelerated, or contributed to the condition that is now disabling you.
Insurance Adjusters Are Not Always Familiar with Georgia Law
In our experience, many adjusters who handle Georgia workers’ comp claims are located in other states. They work claims across multiple jurisdictions at once. For example, adjusters based in Florida or Tennessee commonly handle claims from Georgia and many other states. Yet workers’ compensation laws differ significantly by state.
Common Justifications for Denying Claims that Involve Previous Injuries
Workers’ compensation claims adjusters will typically review a claimant’s complete medical history looking for ways to deny the claim. We regularly see them deny claims when they find any evidence of a prior injury or a pre-existing condition somewhere in the claimant’s history.
Justifications for denial will include phrases like…
- “Your MRI showed degeneration.”
- “You already had a bad back.
- “This was a pre-existing condition.”
However, none of those scenarios automatically disqualify you from receiving workers comp benefits in Georgia.
It’s surprising how many claims are denied with little investigation, even when medical records show the worker’s condition became worse while performing physically demanding job duties.
Let’s look at a real worker’s comp case we handled involving an initial denial based on a prior injury.
Case Example: We Won Using Comprehensive Medical and Employment Records
Stow Garvin & Glenn recently handled a workers’ compensation appeal involving a manufacturing worker with a serious back injury.
Insurance Denied the Claim Based on a Prior Back Injury
Our client had undergone prior back surgery approximately six years earlier. After recovering, he returned to physically demanding work and eventually began working at a food manufacturing facility performing heavy labor. His daily work included:
• Lifting
• Bending
• Pushing heavy materials
• Standing for 12-hour shifts
• Working overtime
The employer and insurer aggressively defended the case arguing that his new injury was not work-related because of his prior back problems. The worker was sent to an IME doctor hired by the insurance company, and the insurer also obtained questionnaire responses from treating providers attempting to argue the injury was unrelated to work.
They had lots of evidence, but they used it selectively to support a legally invalid argument.
What the Insurance Company Overlooked
Medical records do not always tell the entire story. So, during litigation we required the employer to produce the worker’s personnel file and time records – evidence the insurer had ignored.
The combination of medical and employment records showed a more complete and legally compelling story. Our client had…
• Gone roughly six years without back treatment
• Continued performing demanding physical labor
• Worked overtime
• Accumulated vacation time
• Passed a pre-employment physical
• Successfully performed his job duties
Evidence that Mattered
The State Board of Workers’ Compensation specifically found the worker’s time records supported his testimony that he was not having disabling problems before his new injury developed.
In preparing for the hearing, we focused heavily on preparing our client. We did not simply tell him to “show up” for testimony. We spent time preparing him for deposition and hearing testimony so he could clearly explain
• his prior medical history;
• his recovery;
• his ability to work before the injury worsened;
• and how his symptoms changed while performing his job duties.
Importantly, our client did not try to hide his prior back problems. He acknowledged them directly while consistently explaining that he had recovered enough to perform demanding work before his condition deteriorated on the job.
We also pointed out something else important: although the insurance company questioned our client extensively about prior medical history, they did not produce evidence showing he was actively treating for disabling back problems before the work injury.
In other words, the insurance company’s own aggressive defense helped show that our client had been functioning normally before his work duties aggravated his condition.
Our Client Won Increased Benefits Plus Penalties and More
The case was ultimately heard by the Appellate Division of the Georgia State Board of Workers’ Compensation. The Appellate Division found that our client sustained a work-related injury, despite evidence of a prior back problem.
The Board concluded that the client suffered a covered back injury directly related to his job duties and ordered the Insurer to provide medical and income benefits, including the following:
• Pay more than a year of past-due weekly workers’ compensation benefits
• Pay 15% penalties on overdue benefits
• Provide ongoing weekly income benefits
• Authorize medical treatment
• Reimburse medical expenses
The Appellate Division specifically recognized that aggravations of pre-existing conditions may still be compensable under Georgia workers’ compensation law. If you would like to see the official summary of this case from the Georgia State Board of Workers’ Compensation, including the initial denial and the appeal win, click here.
Key Take-Away: Do Not Assume the Insurance Company Is Correct in Their Denial
One of the biggest mistakes injured workers make is assuming a denial automatically means they do not have a case. That is not always true.
We routinely win denied claims involving…
• Pre-existing back conditions
• Prior surgeries
• Degenerative disc disease
• Repetitive lifting injuries
• Gradual worsening symptoms
• Disputes involving IME doctors
Many of these cases are far more legally complicated than adjusters initially suggest.
Talk to a Georgia Workers’ Compensation Lawyer Before Giving Up
If your workers’ compensation claim was denied because of an old injury or pre-existing condition, it is important to have the case reviewed by someone familiar with Georgia workers’ compensation law. An old injury does not automatically prevent you from receiving benefits.
In many cases, the real legal question is whether your work activities aggravated, accelerated, or contributed to the condition that is now disabling you.
Our firm handles denied and disputed Georgia workers’ compensation claims throughout North Georgia, including cases involving pre-existing conditions, IME disputes, denied surgeries, and gradual onset injuries. If you’d like a free consultation to discuss your denied claim please give us a call at (770) 534-5265.