By: Wesley R. Moore, Esq.
When a claimant has waited one year or more in between receiving medical treatment for an occupational injury, it can be confusing to figure out whether the employer/insurer can deny further treatment based on the statute of limitations and if so, determining which statute of limitations would apply. It is an understandable instinct to want to outright deny the treatment due to the passage of time, but answering a few key questions will help determine which of the two statute of limitations defenses, “all issues” or “change of condition,” apply and therefore the defensibility of any denial. In essence, as outlined below, if the claimant did not receive income benefits, then the claim is likely an “all issues” claim and the statute of limitations bars additional medical benefits after one year of the last employer-provided medical treatment. If the claimant ever received income benefits and the entire claim was not validly controverted, the claimant can be entitled to either lifetime medical or 400 weeks of medical benefits for injuries occurring after 7/1/13 in non-catastrophic cases.
What do you need to know?
- Has the claimant ever received income benefits? This
determines whether it is an “all issues” claim or a “change of condition”
claim and the statute of limitations varies.
- All Issues: If no income (disability) benefits have been paid, even if medical expenses have been paid, then the claim would be considered “all issues.” This is true even if the employer initially paid income benefits but later controverted the claim. (However, if an award by the Board establishes compensability, even if medical only, “change of condition” would be applicable instead).
- Change of Condition: If the employer/insurer have accepted liability by paying weekly benefits or there has been an award adjudicating the claimant’s condition, then the claim is a “change of condition.”
- Once you have determined whether the claim is “all
issues” or “change of condition,” apply the appropriate statute of
- All Issues : O.C.G.A. 34-9-82 (for accidents on or
- Statute of limitations bars both income and medical benefits
- Claimant must file a claim:
- One year from the date of injury;
- One year from the date of last employer-provided medical treatment; or
- Two years from the last payment of weekly benefits (applicable when the employer/insurer validly controverts after paying benefits or the employer pays the employee the regular salary in lieu of benefits without filing the State Board forms reflecting such payment)
- All Issues : O.C.G.A. 34-9-82 (for accidents on or after 7/1/78)
- Change of Condition: O.C.G.A. 34-9-104
- Statute of limitations bars income benefits but not medical benefits. Therefore, if it is a “change of condition” claim, the claimant can get lifetime medical benefits for injuries before July 1, 2013 and up to 400 weeks of medical benefits for non-catastrophic injuries after July 1, 2013.
- Claimant must file a claim for additional income benefits:
- If seeking TTD or TPD benefits, not more than two years since the last payment of income benefits otherwise barred from additional TTD/TPD benefits.
- If seeking PPD benefits, not more than four years since the last payment of TTD or TPD income benefits.
Please note that these statutes apply to occupational injury claims occurring after 7/1/78 and there are different statutes for occupational disease and death claims. Additionally, a fictional date of injury may be asserted to toll the statute of limitations. The above outline is intended as a general guide but as always, please feel free to contact your KDA attorney with specific claim questions.