Res Judicata in Workers’ Compensation Claims

Written by: Ann Baird Bishop, Esq.

In a case decided October 29, 2020, the Court of Appeals held, among other things, that while the doctrine of res judicata applies in workers’ compensation cases, it does not preclude litigating a request for certain medical treatment a second time.  In Trejo-Valdez v. Associated Agents et al. (A20A1499, 10/29/2020), the claimant had litigated a request for approval of a spinal cord stimulator.  The award, issued in July 2018, of the administrative law judge denied the request for a spinal cord stimulator but designated a new authorized treating physician.  Thereafter, the new authorized treating physician recommended a trial of a spinal cord stimulator which the employer/insurer, again, denied.  At the resultant hearing, the employer/insurer argued that the July 2018 award was res judicata and the claimant’s entitlement to a spinal cord stimulator could not be litigated, again.

The administrative law judge disagreed and allowed the hearing to go forward, noting that “[w]orkers’ compensation claims are constantly evolving and an employee’s entitlement to benefits, especially medical benefits, changes in accordance with the employee’s changing medical condition and the treatment recommendations of the employee’s physicians.”  At the second hearing, the administrative law judge granted the request for a spinal cord stimulator.  The Appellate Division affirmed.  The Superior Court reversed, holding that the medical issue which was decided in the March 2019 order was essentially the same as that previously tried and decided in the July 3, 2018 award.  The Superior Court concluded that res judicata prevented the second hearing.

The Court of Appeals granted the Application for Discretionary Appeal and reversed the Superior Court.  The Court of Appeals noted that the doctrine of res judicata, unquestionably, applies to workers’ compensation claims citing Vought Aircraft Industries v. Faulds, 281 Ga. App. 338, 636 S.E. 2d 75 (2006) and Webb v. City of Atlanta, 228 Ga. App. 278, 491 S.E. 2d 492 (1997).  Cases applying res judicata in workers’ compensation matters go back even further.  In Woods v. Delta Airlines, 237 Ga. 332, 224 S.E. 2d 763 (1976), the Supreme Court agreed that res judicata may apply in workers’ compensation matters.  Even earlier, the Court of Appeals, in Connecticut Indemnity Company v. Gaudio, 116 Ga. App. 672, 158 S.E. 2d 680 (1967), held that res judicata can be used in workers’ compensation matters.

However, before res judicata precludes litigating an issue which has been litigated previously, it must be shown that the issue being litigated is “identical” to the issue previously decided.  Citing Aldrich v. City of Lumber City, 273 Ga. 461, 542 S.E. 2d 102 (2001), the Court of Appeals stated:

A former judgment binds only as to the facts in issue and events existing at the time of such judgment, and does not prevent a reexamination even of the same questions between the same parties, if in the interval the material facts have so changed or such new events have occurred as to alter the legal rights or relations of the litigants.

While res judicata certainly can apply if a claimant in a workers’ compensation case attempts to relitigate an issue where there have been no changed circumstances, because workers’ compensation claims are ongoing and the right to medical treatment can last at least 400 weeks, where circumstances change, a particular treatment could be found not reasonable at one time but could become reasonable.  When determining whether to raise the res judicata defense, it is important to confirm that not only the sameThe Court of Appeals held that res judicata did not bar the claimant’s second request for a spinal cord stimulator for two (2) reasons: (1)  The Court noted that the claimant is entitled to medical care and services, prescribed which are reasonably required and appear likely to effect a cure, give relief, or restore the employee to suitable employment.  In the 2018 order, the administrative law judge found that the preponderance of evidence did not establish that the spinal cord stimulator was reasonably required and likely to effect a cure, give relief, or restore the employee to suitable employment at that time.  However, the administrative law judge went on to order that the claimant receive ongoing medical benefits and designated a new physician.  After the new physician ordered a trial of the spinal cord stimulator, circumstances had changed.  (2)  The Court of Appeals recognized that the issues were not identical.  The new authorized treating physician did not recommend a permanent installation of a spinal cord stimulator but, rather, a trial period to determine whether permanent implantation would be appropriate.  Accordingly, because the issues were not identical, the doctrine of res judicata could not preclude litigating the second request for a spinal cord stimulator.