Case Study: A Ten Year-Old Injury Rears Its Head (or Knee)

I recently evaluated a claim with facts somewhat similar to the following: The claimant sustained a right knee injury in January of 2003, which was accepted as compensable. The claimant received medical benefits and was paid income benefits for a period of time until being released back to regular duty work in October of 2003. Fast forward ten years (during which time the claimant continually worked her regular duty job), and in October of 2013, the claimant now says that she needs a right knee replacement. What’s more, she says that it’s related to the 2003 work accident. Is there a statute of limitation defense? Should this claim be picked up?

First, it’s important to note that under Georgia law, there are two Statutes of Limitation (SOL): the “all issues” SOL, and the “change in condition” SOL. In situations where the “all issues” SOL applies, an injured worker’s claim is completely barred (for both income and medical benefits) if the employee’s claim was not filed (1) within one year of the injury; (2) within one year of the last remedial treatment provided by the employer; or (3) within two years of the last payment of weekly benefits. In general, the “all issues” SOL will apply if no weekly benefits were ever paid (or if they were paid and then later validly controverted). This is true even in “medical only” claims (i.e., if the Employer picks up medical benefits but never pays any income benefits).

Thus, based on the above facts, it is clear that the “all issues” SOL does not apply in this case because the claimant was paid income benefits after her 2003 injury. So what about the “change in condition” SOL?

Generally, the “change in condition” SOL will apply in the event that income benefits were paid after the work accident (either voluntarily or pursuant to a Board order/award). In situations where the “change in condition” SOL applies, there is no bar for a claim for medical benefits, but a claim for TTD/TPD benefits is barred if it isn’t filed within two years of the last date that TTD/TPD were paid, and, further, a claim for PPD benefits is barred if it isn’t made within four years of the last date that TTD/TPD were paid (important note-recent changes in Georgia law, effective for injuries occurring on or after July 1, 2013, place a 400 week cap on medical benefits in non-catastrophic claims).

Thus, because income benefits were paid in 2003, the “change in condition” SOL applies-but does it help us? Regarding medical benefits, as stated above, the “change in condition” SOL will not bar a claim for additional medical treatment so long as it relates to the initial injury. This last point, however, is the kicker–while neither statute of limitation can provide any help in this case as it relates to the claimant’s medical treatment, the claimant still must prove that the knee replacement relates back to the 2003 injury.

Practically, in evaluating this claim, it would be well worth a long look at the claimant’s current knee complaints, her medical history, and the opinions of the claimant’s 2003 authorized treating physician to determine whether her current knee replacement is, indeed, related to her 2003 work accident. Ten years is a long time, and if she was working regular duty during that time, there are numerous non-work related factors which may have contributed to her current knee complaints, such as arthritis, degenerative changes, obesity, etc. An IME is almost certainly warranted to assess the nature of her current complaints and the true cause of her need for a knee replacement.

Thus, in summary, when an old compensable injury pops back up, it is extremely important to go through the checklist for the above statute of limitation defenses outlined above. Moreover, even if neither statute of limitation provides a valid defense, it is nevertheless worth closely scrutinizing the current complaints and the relatedness to the initial injury before making a decision to pick up the claim.

Written By: James Smith, Esq.