Serious work injuries resulting in “catastrophic” designation

Serious work injuries resulting in catastrophic designation

The Georgia workers’ compensation system recognizes the unfortunate fact that some work injuries result in employees never returning back to work.  These serious occupational accidents preclude employees from not only working for their previous employer, but for any employer.  These work injuries are designated as “catastrophic” under the Georgia workers’ compensation law.  See, OCGA 34-9-200.1. This designation allows the injured employee to receive lifetime medical treatment, as well as lifetime indemnity (weekly income) benefits.  Generally, income benefits are limited to either 350 or 400 weeks from the date of accident.

In Georgia, a catastrophic injury often defined as (1) a severe spinal cord injury involving paralysis of an arm, leg, or trunk; (2) an amputation of an arm, hand, foot, or leg involving the effective loss of use of the appendage; (3) a severe brain or closed head injury where there is severe sensory or motor disturbances, as well as disturbances in communication, cerebral functioning or consciousness, or neurological disorders; (4) second or third degree burns over 25% of the employee’s body or third degree burns to 5 percent or more to the face or hands; (5) total or industrial blindness; or (6) any other injury of a nature and severity that prevents the injured worker from being able to perform his or her prior work and any work available in substantial numbers within the national economy for which the employee is otherwise qualified.

If the injury has not been designated as “catastrophic” and the authorized treating physician has released the employee to return to work with restrictions, there is a rebuttable presumption during a period not to exceed 130 weeks from the date of injury, that the injury is not catastrophic.  When an employee suffers an injury that qualifies under the first five categories (appendage amputations, significant burns, severe brain trauma), the catastrophic designation is automatic.  The employer and the insurance company will generally agree with the employee and rehabilitation services, medical treatment, and income benefits will be started.

Most of the litigation and issues stem from the last category where the injury is of a “nature and severity” that prevents the employee from effectively working in any capacity.  The burden of proof will be on the injured worker and his or her attorney to demonstrate that the injury qualifies for this designation.  This burden will likely involve extensive medical opinions and vocational testimony as to the employability of the injured worker.  Predictably, the insurance companies, employers, and self-insurers will contest this designation as much as possible.

Additionally, Social Security disability benefits will play a part in this analysis.  In Georgia, the State Board of Workers’ Compensation may consider the Social Security award as evidence as to whether the work injury may be designated as “catastrophic”.

If you believe your work injury qualifies, please contact Ramos & Law for your free consultation.