April 19, 2011

Subrogation Liens and the "Made Whole" Doctrine Under Georgia Law

by Chuck DuBose, Esq.

In a recent Georgia Court of Appeals case (Austell Healthcare, Inc. v. Scott, Appeal No. A10A2346, decided March 11, 2011) the Court of Appeals held that an employer and its workers’ compensation insurer were not entitled to enforce a workers’ compensation subrogation lien against a settlement of the claim against the third-party tortfeasors. The claimant was injured in an automobile accident while working for Austell Healthcare. Aside from pursuing a workers’ compensation claim he also filed a personal injury lawsuit against several third parties he claimed were responsible for the accident. Austell Healthcare and their workers’ compensation insurer intervened in that suit. However, after the claimant settled the third party claim the trial court granted his motion to extinguish the subrogation lien asserted by the employer and insurer.

Upon appeal, the Georgia Court of Appeals affirmed the dismissal of the subrogation lien. The Court re-affirmed the principle that, in order to recover on a subrogation lien in work-related injuries, the employer must show the employee has been fully and completely compensated, taking into consideration benefits received under the Workers’ Compensation Act, as well as all economic and non-economic losses incurred as a result of the injury. In this particular case, the Court of Appeals noted the fact that the employer and insurer did not present any evidence that the employee had been fully and completely compensated at any point. While the Court of Appeals noted the trial court erroneously concluded the employer/insurer could not show the employee had been fully compensated because there was no liability award (since the parties settled), the Court again noted the fact that the employer/insurer never attempted to introduce any evidence that the employee had been fully and completely compensated at any point, not even at the hearing on the employee’s motion to extinguish the subrogation lien. This case emphasizes the difficulty in recovering on subrogation liens in Georgia but also emphasizes the importance in providing evidence to support the argument that the employee has been fully and completely compensated in order to recover on a subrogation lien.


If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com.

Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

Recent Changes in the Georgia Workers' Compensation Medical Fee Schedule

by Chuck DuBose, Esq.

As of April 1, 2011 the State Board of Workers' Compensation made changes in the Medical Fee Schedule. Notable changes include the following:

1. Maximum allowable reimbursements (MAR) have all been recalculated.

2. CPT codes were updated with code additions, deletions and revisions in accordance with the AMA.

3. Ambulance and Air Service transportation reimbursement rates have increased. (see schedule for Ambulance and Air Service Transportation: http://www.davidandrosetti.com/newsletter/april11/2011%20Fee%20Schedule%20Ambulance%20and%20Air%20transportation.pdf)

4. Non-Emergency Transportation reimbursements have increased. (see schedule for Non-Emergency Transportation: http://www.davidandrosetti.com/newsletter/april11/2011%20Fee%20Schedule%20Non-Emergency%20transportation.pdf)

5. Anesthesia base rate has been increased to $36.56.

6. Home Health Services hourly rates have increased. (see schedule for Home Health Services: http://www.davidandrosetti.com/newsletter/april11/2011%20Fee%20Schedule%20Home%20Health%20Services.pdf)

7. Medical Record copy reimbursement. The minimum charge has increased from $25 to $30 for a request for medical records, plus sales tax and postage (for up to 150 pages), with a $0.20 per page charge for any request that is for more than 150 pages. (see medical record reimbursement requirements: http://www.davidandrosetti.com/newsletter/april11/2011%20Fee%20Schedule%20Medical%20Record.pdf)

8. Pharmaceuticals – See IMPORTANT UPDATE concerning generic prescription drugs versus brand-name prescription drugs and concerning reimbursement for prescription drugs: http://www.davidandrosetti.com/newsletter/april11/2011%20Fee%20Schedule%20Pharmaceuticals.pdf

9. Supplies, DME, prosthetics and orthotics, and rental equipment reimbursement is unchanged from 2010. (see schedule for medical supplies: http://www.davidandrosetti.com/newsletter/april11/2011%20Fee%20Schedule%20Medical%20Supplies.pdf)

The Independent Medical Evaluation ( IME) rates remain unchanged from April 1, 2010; $600.00 for the first hour and $150.00 for each additional 15 minutes. For a no-show at an IME, reimbursement shall be at $150.00. Use state-specific code IME01 when billing for IME.

Also, Physician Testimony/Deposition reimbursement remains unchanged from April 1, 2010; $600.00 for the first hour and $150.00 for each additional 15 minutes.



If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com.

Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

Protection from Falls in the Construction Industry

by Chuck DuBose, Esq.

OSHA Assistant Secretary David Michaels reports that falls are the number one cause of death for workers involved in construction, accounting for more than one-third (actually 34%) of the fatal occupational injuries in construction, ahead of injuries involving being struck by an object, caught-in/between injuries, and injuries involving electrocution. In his statement before Congress last month Assistant Secretary Michaels further reported that nearly half (48%) of all fatal falls in private industry involved construction workers. View the complete transcript of Assistant Secretary Michaels’ statement to Congress: http://www.davidandrosetti.com/newsletter/april11/OSHA_SecretaryMichaels.pdf

On April 8, 2011 OSHA issued Guidelines on Fall Protection in Residential Construction. The new Guidelines issued by OSHA provide safety methods employers can implement during various stages of construction to prevent fall-related injuries and deaths, including anchors for personal fall arrest systems and fall restraints, safety net systems, guardrails, ladders, and scaffolds for activities such as installing roof sheathing, weatherproofing a roof, and installing walls and subfloors, etc. See the OSHA Guidelines on Fall Protection: http://www.davidandrosetti.com/newsletter/april11/OSHA%20Guidelines-Fall%20Protection%20in%20Residential%20Construction.pdf


If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com.

Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

State Board of Workers’ Compensation to Host Regional Seminars in 2011

The Georgia State Board of Workers’ Compensation will be holding four seminars throughout the State this month to assist and educate those who work within the workers’ compensation system in Georgia. These seminars will benefit employers, human resources managers and risk managers, claims adjusters, rehabilitation specialists, medical service providers, and workers’ compensation attorneys and paralegals. The first seminar is scheduled for Friday April 15, 2011 in Columbus. See the full schedule below:

Friday, April 15, 2011 Columbus, GA
Thursday, April 21, 2011 Valdosta, GA
Wednesday, April 27, 2011 Kennesaw, GA
Friday, May 13, 2011 Brunswick, GA

These seminars will be a special benefit to anyone involved in the workers’ compensation system in Georgia. The discussions will include information about income benefits and medical benefits available in Georgia, accessing awards online, the interaction between workers’ compensation and other human resource issues, common litigated issues in workers’ compensation claims, the transition involved in phasing out the Subsequent Injury Trust Fund, and other valuable topics. See Brochure for registering for one of the seminars: http://www.davidandrosetti.com/newsletter/april11/2011%20State%20Board%20Regional%20Seminar%20Brochure.pdf


If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com.

Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

March 11, 2011

Immigration Reform Update: House Bill 87

By: Alissa C. Atkins, Esq.

On the heels of Senate Bill (SB) 7, which seeks to prevent undocumented workers from receiving workers' compensation benefits, the Georgia House of Representatives recently voted to pass House Bill (HB) 87. This bill is modeled on the Arizona law that is currently being challenged on constitutional grounds. Should HB 87 become law some of its provisions may significantly affect employers throughout Georgia.

Essentially, HB 87 authorizes state and local police to verify the immigration status of certain suspects. It also mandates that private employers use E-Verify to confirm newly hired workers are legally entitled to work in the United States, and criminally penalizes applicants who "willfully and fraudulently" use false identification to seek employment.

Now that the House has passed the bill, it will move to the Senate. If passed by the Senate the bill will be submitted to Governor Nathan Deal. While the bill is not yet law, employers are questioning what might be required of them. As it stands, the bill does not require employers to use E-Verify to determine work status for current employees. However, the bill underwent 16 drafts prior to passage by the House, so there will likely be more versions of the bill to come. We will continue to update you on developments with the immigration legislation regarding employment and workers' compensation issues.

Read more information on E-Verify:
http://www.uscis.gov/portal/site/uscis/menuitem.eb1d4c2a3e5b9ac89243c6a7543f6d1a/?vgnextoid=e7f29589cdb76210VgnVCM100000b92ca60aRCRD&vgnextchannel=e7f29589cdb76210VgnVCM100000b92ca60aRCRD

If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com.

Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

Chronic Pain and Workers' Compensation Claims

By: Michael E. Memberg, Esq.

The term “pain” has many connotations. Webster’s Dictionary provides at least nine definitions of the word, including: “[a] symptom of some physical hurt or disorder”; “[e]motional distress; a fundamental feeling that people try to avoid”; and “[a] somatic sensation of acute discomfort.”

Recently, TIME conducted a special investigation on this issue ranging from diagnosis to treatment. Articles include discussions on various chronic pain conditions (e.g. chronic regional pain syndrome or fibromyalgia), traditional medical treatments (e.g. medication, surgery, spinal cord stimulators), and alternative treatments (e.g. acupuncture), from the perspective of both medical professionals and patients. The lead article can be viewed here: http://www.time.com/time/health/article/0,8599,2057269,00.html

Both the causation and treatment of chronic pain make it difficult for employers/insurers to handle claims and limit exposure. Every person handles pain differently—one employee might return to work following back surgery, and another might remain totally disabled following a wrist sprain. Furthermore, doctors vary greatly in their opinions on chronic pain—some will immediately refer a patient to pain management, while others believe pain is more psychosomatic and easily exaggerated.

Chronic pain is frustrating for all participants in a workers’ compensation claim—doctors have difficulty diagnosing and treating the pain; employees feel like no one is listening to them; and employer/insurers are often left to pay for years of ongoing benefits. The resulting effect is that workers’ compensation claims involving chronic pain are more likely to linger and are difficult to resolve, particularly in cases where Medicare concerns will arise.

As claims involving chronic pain become increasingly common, it is even more important to maintain good communication with the injured worker and the treating physicians. Employers/insurers may need to consider more alternative treatments options such as massage therapy and acupuncture. As in any claim, there will be red flags and warning signs in these cases that call into question the legitimacy of the claim. However, the longer such a claim takes to resolve the more important it is for the participants involved to consider all options.


If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com.

Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

Employee’s Willful Misrepresentation May Bar Recovery of Benefits

By: David W. Willis, Esq. and Michael E. Memberg, Esq.

In Georgia Elec. Co. v. Rycroft, 259 Ga. 155, 378 S.E.2d 111 (1989), the Georgia Supreme Court set forth a three part test, whereby an employee’s intentional misrepresentation of his medical condition at the commencement of his employment could bar recovery of workers’ compensation benefits.


The 3 Part Test:

The employee knowingly and willfully made a false representation as to his physical condition at the time of hire;
The employer relied upon the false representation, and this reliance was a substantial factor in the hiring; and
A causal connection existed between the false representation and the employee’s injury.

The Rycroft defense provides employers/insurers with a defense to a workers’ compensation claim if all three elements can be proven by a preponderance of the evidence. A common scenario where the Rycroft defense may arise is when medical records obtained following a work injury indicate the injured worker had a previous injury to the same body part, and this injury or condition was not disclosed to the employer at the time of hire. However, it is incumbent upon employers to ask the right questions. This is most often done in the form of an employment “physical” and/or post-hire medical questionnaire.

Any statements made by the employee, whether written or oral, which intentionally misrepresented his or her medical condition, would satisfy the first element of the Rycroft defense. However, subjective statements such as “I will have no problem performing a job that requires frequent lifting over 50 pounds” may not be specific enough. Statements such as “I have never had a previous back surgery” (when later found to be false) are more along the lines of what is contemplated by Rycroft. The nature of such statements is a fact-specific analysis and will be made on a case-by-case basis.

The second element of Rycroft requires an employer to prove they relied upon the injured worker’s misrepresentation in their hiring decision. The best measure of employer reliance is whether the company still would have hired the employee for the position if that person had not misrepresented his or her condition. Such evidence would usually be obtained through testimony of representatives(s) from the employer. A judge would consider the physical demands of the job when determining whether the employer relied on the misrepresentation—the more strenuous the job, the more likely an employer would turn away a job applicant who reported a previous injury. Additionally, employers who require physicals may have a difficult time establishing reliance on false statement(s) if the employee otherwise passes the physical.

The third element of Rycroft requires a causal connection between the misrepresentation/prior condition and the work injury. An employer does not have to prove the pre-existing condition led to the injury, but there must be some connection between the two. One way to establish this is for an employer/insurer to demonstrate the work injury was more severe because of the misrepresented condition. For example, if an employee re-injures his or her lumbar spine at the site of an undisclosed prior surgical fusion, medical evidence (from records or a medical deposition) may support a causal connection between the injury and the misrepresentation.

In practice, it is often challenging for an employer/insurer to establish the three elements needed for a Rycroft defense, but it should always be considered if the above circumstances arise. The real lesson of Rycroft is that an ounce of prevention is worth a pound of cure. While it may sometimes be cost-prohibitive to require job applicants to undergo a physical or complete a medical questionnaire, there are several opportunities in the hiring process to discover information which could prove invaluable should an injury result down the road.

If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com.

Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

Updates in Trucking Safety

By: Michael E. Memberg, Esq.

The U.S. Department of Transportation's Federal Motor Carrier Safety Administration (FMCSA) recently issued a regulatory proposal that would revise hours-of-service (HOS) requirements for commercial truck drivers. Under the terms of a court settlement agreement, the FMCSA has to publish a final HOS decision by July 26, 2011.

The proposed changes would include the following:
Drivers can restart their 60/70 hour work week by taking off 34 consecutive hours, but the restart period must include two consecutive off-duty periods from midnight to 6:00 a.m.
All driving must be completed within a 14-hour workday, and all on-duty work-related activities must be completed within 13 hours to allow for at least a one hour break.
Flexibility to extend a driver's daily shift to 16 hours twice a week to accommodate for issues such as loading and unloading at terminals or ports, and allowing drivers to count some time spent parked in their trucks toward off-duty hours.

Commercial truck drivers who violate the proposed rule would face civil penalties of up to $2,750 for each offense. Trucking companies that allow their drivers to violate the proposal's driving limits would face penalties of up to $11,000 for each offense.

Beyond the civil penalties, an increase in driver safety can help reduce the number of work related accidents. Furthermore, there could be a defense to a workers’ compensation claim if the driver willfully disregarded any of these new rules. While willful misconduct is often difficult to prove as a defense in workers’ compensation claims, since the system is “no fault”, a violation of new regulations such as being proposed may open the door for more companies to explore the merits of asserting such a defense.

Additionally, the FMCSA recently enhanced its Pre-Employment Screening Program (PSP) by adding data for co-driver safety and post-crash violations to the roadside inspection and crash records previously available. The PSP report also now shows the date drivers' safety records are updated. Pre-employment checks are a critical part of the overall safety and risk management plan for trucking companies. By taking full advantage of the PSP, trucking companies can help keep dangerous drivers off the road and limit their exposure for workers’ compensation claims.

Further details are available on the Federal Motor Carrier Safety Administration website at http://www.fmcsa.dot.gov

If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com.

Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

Georgia SuperLawyers

Super Lawyers magazine recently recognized three David and Rosetti Workers' Compensation Defense Attorneys for their achievements. Mike Rosetti was again named a "Super Lawyer" and Christina Bevill and David Willis were named "Rising Stars". Their hard work and dedication to client service have been key ingredients to their success.

Congratulations to all three attorneys!

February 10, 2011

Proposed Georgia Legislation Seeks to Bar Workers’ Compensation Benefits to Undocumented Workers

By: Alissa C. Atkins, Esq.

On January 25, 2011, a bill was introduced in the Georgia Senate seeking to bar receipt of workers’ compensation benefits by those not legally authorized to work in the United States. The Senate’s First Reader Summary explains that the bill will amend O.C.G.A. § 34-9-1, which relates to general provisions of workers’ compensation, "so as to provide that benefits under such chapter shall not be paid to noncitizens who are not employed legally; to provide that such payments shall not be made unless the noncitizen is present in this country legally at the time such payments are made; to provide for related matters; to repeal conflicting laws; and for other purposes."

The bill was sponsored by six senators, and introduced by Sen. Bill Heath, a Republican from Georgia’s 31st District. Please click here to read the full text of SB 7: http://www.davidandrosetti.com/newsletter/pdf/senatebill7.pdf

After the bill was read to the Senate on January 25th, it was sent to the Senate’s Insurance and Labor Committee for review and public hearings on the topic. The full Senate could vote on the bill in the next 30 to 45 days. The wording of the bill is subject to change, and therefore it is early to speculate on the potential ramifications if the bill is signed into law. Comparable bills have been introduced over the past several years in other states. The result has been the bills either languishing in committee or simply not garnering enough votes to become law. One source at the legislature suggests that the recent November 2010 elections showed increasing support across the country for conservative ideals, leading to renewed efforts at passing legislation to deal with the issue of undocumented workers. Similar bills are now also pending in New Hampshire, South Carolina, and Montana.

As with much legislation, supporters and detractors of the bill have emerged. A number of Georgia claimant attorneys object to the bill. However, many employers and insurers have also expressed concerns about the potential effect the legislation will have on the future of Georgia’s workforce. The key points raised by each side are as follows:

Supporters of S.B.7 contend:

The bill intends to enforce federal employment laws already in existence;
Immigrants will not be prevented from working as long as they obtain proper documentation authorizing their employment;
The overall cost of workers’ compensation claims is expected to decrease, and as a result, workers’ compensation premiums could decrease for employers who comply with the terms of the new law;
Undocumented workers do not have an inalienable right to employment in the United States; and
The bill will not affect employers who only employ workers who are legally authorized to work in the United States.

Opponents of S.B.7 contend:

The bill will unfairly preclude undocumented workers from obtaining employment;
Unscrupulous employers may attempt to hire undocumented workers strictly to avoid exposure for potential workers’ compensation benefits;
If employers hire undocumented workers for this reason, applicants legally entitled to work in the United States will suffer as they will be more expensive to employ;
The exclusive remedy provision of the Workers’ Compensation Act would no longer apply. This provision requires workers to file claims for work-related injuries through the State Board of Workers’ Compensation (even when the worker was at fault or caused the accident) and provides employers with protection from lawsuits in other court systems. Since lawsuits based in tort may subject the liable party to exposure for pain and suffering, employers and insurers could potentially face higher costs for claims involving undocumented workers not otherwise covered by the Act; and
While farms are exempt from the Act, industries with production needs (migrant workers, construction and other fields) which are heavily reliant upon day laborers could be hard hit.


If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com.

Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

State Board of Workers’ Compensation Update

By: David W. Willis, Esq.

Deadline Approaching for Filing the WC-26: March 1, 2011

A WC-26 Consolidated Yearly Report of Medical Only Cases and Annual Payments on Indemnity Claims must be filed with the Board on or before March 1st following each calendar year with respect to all medical and indemnity payments for the previous year for work related injuries. The State Board mandates that a WC-26 be filed annually even if no reportable injuries or payments occurred during the reporting year. For questions or more information please contact a David & Rosetti attorney at 404-446-4488 or you may call the State Board call center at 404-656-3818.


Publishing of Appellate Division Awards

Chairman Rick Thompson recently spoke at the Atlanta Bar Association Worker' Compensation Section luncheon and confirmed that the Board is now publishing Awards issued by the Appellate Division in accordance with O.C.G.A. §34-9-12(b). Chairman Thompson stated that these decisions, while not binding give a window into the Appellate Division’s thinking on relevant and recurrent issues. Appellate decisions are currently available for Awards dating back to October 1, 2009. There are no immediate plans to retroactively publish Awards before that date, mainly because of time, cost and manpower concerns.

To view copies of Awards from the Appellate Division you can visit the State Board at http://sbwc.ga.gov and click on the “Published Awards” section at the top left corner. You can perform a key word search for topics of interest. The Board has taken measures to redact the names of the parties to protect their privacy.


If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com.

Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

OSHA Update

By: David W. Willis, Esq.

On January 25th the Occupational Safety and Health Administration (OSHA) announced it had temporarily withdrawn from review by the Office of Management and Budget its proposal to restore a column for work-related musculoskeletal disorders on employer injury and illness logs. OSHA stated this action was undertaken in an effort to obtain more input from small businesses on the impact of the proposal. According to the Bureau of Labor Statistics, these types of conditions accounted for 28% of all reported workplace injuries and illnesses resulting in lost time in 2009. According to OSHA it plans to hold a meeting with the U.S. Small Business Administration's Office of Advocacy to "engage and listen to small businesses" about the agency's proposal. See www.OSHA.gov for more information.


If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com.

Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

In the News...

Alissa Atkins Quoted in Business Insurance

Alissa Atkins was recently featured in Business Insurance and is quoted on page 18 of the January 31st issue in the article "States may bar comp for illegal immigrants". Read the article:
http://online.qmags.com/BUI013111?sessionID=D86A73F3BED90C68AD3A8ED73&cid=1398937&eid=16115

New Associates at David & Rosetti, LLP

David & Rosetti, LLP welcomes Michael Memberg and Jennifer Smith as new associates of David & Rosetti, LLP.

Michael received his J.D. in 2008 from the Walter F. George School of Law at Mercer University. He focuses his practice on workers' compensation claims but also has experience on subrogation matters and representing insurers in the defense of general liability claims. Michael’s article, "Tightening the Belt: The Compensability of Gastric Bypass Surgery under the Georgia Workers’ Compensation Act," was published in the State Bar of Georgia Workers' Compensation Section Newsletter, Summer 2007. He was also selected in December 2010 to be a guest on The Layman’s Lawyer, a radio program sponsored by the Atlanta Bar. Michael is active with the Pro Bono Partnership of Atlanta and was recently recognized for his participation.

Jennifer also practices in the area of workers’ compensation defense. She received her J.D., cum laude, from Georgia State University School of Law in 2009. Prior to practicing law, Jennifer worked for nearly ten years with Resurgens Orthopaedics, a large Atlanta-area medical practice. As Director of Reimbursement she handled health insurance contracts, structured workflow and training programs, and designed systems to increase revenue. She also spoke at numerous seminars regarding health insurance contract reimbursement. Today she continues her involvement with the Atlanta Volunteer Lawyers Foundation, an organization she joined during law school.

For more information about Michael and Jennifer please visit our website at www.davidandrosetti.com or call us at (404) 446-4488.

January 26, 2011

Does immigration fraud affect an employee’s right to workers’ compensation income benefits?

By Lindy Z. Kerr

In Bollinger Shipyards, Inc. v. Director, OWCP (Rodriguez), 604 F.3d 864 (5th Cir), the 5th Circuit in Louisiana saw the intersection of federal workers’ compensation law under the Longshore Harbor Workers’ Compensation Act (LHWCA) and issues that commonly arise when undocumented workers are disabled as the result of a work injury.

The court held that an undocumented worker injured in the United States was entitled to Federal Workers’ Compensation benefits under the Longshore Harbor Workers’ Compensation Act (LHWCA). The decision is consistent with the position Georgia and other states have taken in state workers’ compensation claims.

In the case, employee Rodriguez falsely told his employer he was a U.S. citizen at the time of hire and provided a false Social Security number. Bollinger Shipyards uncovered the fraud after the employee was injured. In the workers’ compensation claim, the company argued Rodriguez was precluded from workers’ compensation benefits because of his immigration status and fraud. The Court disagreed, reasoning that the plain language definition of “employee” in the LHWCA does not preclude undocumented workers. The Court also rejected the argument that payment of income benefits would be at odds with the holding in the United State Supreme Court case of Hoffman Plastic Compounds, Inc. v. NLRB, 535 U.S. 137, 147 (2002). In Hoffman, the Supreme Court held the National Labor Relations Board could not award back pay to an undocumented alien who had never been legally authorized to work in the United States as such relief was contrary to federal immigration policy in the Immigration Reform and Control Act of 1986 (IRCA).

Georgia has taken a position similar to the federal court in Rodriguez. As set forth in several appellate decisions following Hoffman Georgia has rejected the argument that an undocumented worker does not meet the definition of “employee” under the Act. Georgia courts have also struck down the argument that paying income benefits to an undocumented worker is at odds with federal immigration policy as set forth in IRCA. In fact, Georgia has held that excusing employers from paying workers’ compensation benefits would reward employers for hiring illegal workers. See Earth First Grading v. Gutierrez, 270 Ga.App. 328, 606 S.E.2d 332 (2004); Continental Pet Technologies, Inc. v. Palacias, 269 Ga. App. 561, 604 S.E.2d 627 (2004). But see Martines v. Worley & Sons Const., 278 Ga. App. 26 (2006)(where light duty work is offered contingent on the claimant bringing documents which prove he can work legally his failure to produce such documents may justify a suspension of weekly benefits).

For questions about Longshore matters contact Lindy Kerr at (404) 446-4486. For questions regarding undocumented workers please contact David Willis at (404) 446-4491.

If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com. Nothing contained in this newsletter should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

Study shows more doctors are dispensing drugs at a cost to insurers

By Lindy Z. Kerr

A recently published study from The National Council on Compensation Insurance (NCCI) concludes more doctors are dispensing drugs directly from their office, and the practice is costly. The data used in the study was collected on July 1, 2009 and is for medical services provided between 1996 and 2008 for injuries that occurred between 1994 and 2008. Here are some key findings:

Doctor dispensed drugs often increase prescription costs in a claim because the cost per unit of physician-dispensed drugs is often higher than the cost per unit of the same drug dispensed by a pharmacy.
Nationally, workers’ compensation costs arising from physician-dispensed drugs rose significantly in 2008. In Georgia, there was a higher than average percentage spent on physician dispensed medications. Other states with higher than average percentages include South Carolina, Florida, and Alabama.
In Georgia, the practice of physicians dispensing medication has increased significantly. In 2007 physician dispensed medication only accounted 15% of the total spent on medications. In 2008 physician dispensed medication accounted for over 30% of the total spent on medications.

Ways to keep medicaton costs down:
Most employees have a pharmacy card for filling prescriptions. When possible, encourage employees to fill prescriptions at the pharmacy. Consider contacting the physician’s workers’ compensation coordinator and request medications not be filled at the doctor’s office. Even if the treating physician is not filling prescriptions in house, medication is a costly component of most workers’ compensation claims. Particularly with expensive medications or narcotics, it is important to find out why the particular medication is prescribed, how long it will be prescribed, and whether there are cheaper alternatives. In short, communication with the doctor’s office is key to controlling costs.

If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com. Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.

Administrative Law Judges rotate territories

By Lindy Z. Kerr

Under the administration of Chief Judge Richard S. Thompson, the Board is rotating the Administrative Law Judges’ hearing territories each year. The Board recently released the list of territories for each ALJ for 2011. Notable changes include the rotation of ALJs Hartin, Mason, and Imahara to Atlanta. ALJs Belk, Snow, Fain, and Spalding are no longer hearing cases in Atlanta. ALJ Jocoy was rotated to Laurens County (Dublin), Tift County (Tifton), and surrounding counties. Also, ALJ Bohler left her position in 2010 to go into private practice. Therefore, cases with venue in Glynn County (Brunswick), Ware County (Waycross) and surrounding counties do not have a particular judge assigned until the time of the hearing.

For a comprehensive list of each judge’s territories, please see this document:
http://www.davidandrosetti.com/newsletter/pdf/aljhearing.pdf

If you have questions or comments, please reply to this post or contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com. Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or david.willis@davidandrosetti.com.