I’ve Got 99 Problems, but a Hernia Ain’t One
By: Sara Phillips
In Georgia, hernia injuries receive special attention in that they are covered by their own statute, O.C.G.A. § 34-9-266. In order for hernia injuries to be covered under workers’ compensation, five factors must be met: (1) there was an injury resulting in hernia; (2) the hernia appeared suddenly; (3) the hernia was accompanied by pain; (4) the hernia immediately followed an accident; and, (5) the hernia did not exist prior to the accident for which compensation is claimed. The Georgia Supreme Court confirmed that the aforementioned language was meant to set a higher standard in a claimant’s burden of proof for injuries involving hernias in Hardware Mutual Casualty Co. v. Sprayberry, 195 Ga. 393 (1943).
Georgia Courts interpreted the statute quite strictly in terms of defining the word “suddenly.” In Liberty Mutual Ins. Co. v. Blackshear, 197 Ga. 334 (1944), the Georgia Supreme Court ruled that a hernia, although it could have been the result of compensable injury, is not compensable should it only appear seven to 10 days after the compensable injury. Since the hernia was not immediate, it was not covered under the workers’ compensation act. That decision was a departure from the previous suggestion by the Georgia Court of Appeals in Hardware Mutual Casualty Co. that if a hernia occurred within a short interval of time “for the effect to follow the cause in the usual course of nature,” then it was compensable. The Court of Appeals further clarified its interpretation of the timing element in Standridge v. Candlewick Yarns, 202 Ga.App. 553 (1992). In the latter, a claimant sustained a compensable back injury. While later performing home exercises pursuant to the compensable injury at the direction of an authorized provider, the claimant performed a movement resulting in an inguinal hernia. However, the court found that the superadded injury was not compensable as it “did not occur immediately and without substantial interval” following the work-related accident. Id.
Of course, Standridge did more than clarify the timing element of hernia claims; it also indicated the specificity of the language in the hernia statute prevents hernia injuries from being compensable as a superadded injury as a whole.
The statute is also specific in stating that hernias existing prior to the accident are not compensable. However, there are very rare instances in which a claimant may be entitled to disability benefits, but not medical treatment related to the hernia. In Union City Auto Parts v. Edwards, 263 Ga.App. 799 (2003), the claimant had previously undergone surgery to remove one of his kidneys. Following the surgery, the claimant developed two hernias at the incision site. The hernias were exacerbated by the claimant’s involvement in a compensable work accident. The Court of Appeals in Union City found that medical treatment related to the treatment of the hernias was barred citing Boswell v. Liberty Mutual Ins. Co., 77 Ga.App. 556 (1948). In Boswell, the Court of Appeals ruled that medical treatment for pre-existing hernias was to be barred. However, denial of medical treatment for pre-existing hernias does not preclude a claimant’s recovery of compensation benefits for the total period of disability resulting in incapacity from work as an aggravation of the hernias if the aggravation was otherwise the result of a compensable injury.
Georgia Courts have allowed an exception for denying compensation benefits for an otherwise compensable hernia claim. If a claimant sustains a hernia injury that meets all of the necessary five criteria of the hernia statute, but the claimant refuses surgery as treatment for that hernia, then the employer and insurer are entitled to suspend the claimant’s indemnity benefits unless and until such time as the claimant agrees to undergo the surgery. Refusal of surgery in a compensable hernia case is only permissible when surgery to repair the hernia would be contraindicated or dangerous as result of extenuating health concerns.
The best way to determine the compensability of a hernia claim is to first review the five-factor test identified in the statute to see if the injury meets those criteria. If there are suspicions that the hernia did not occur at work, or there was a delay in the appearance of the hernia following an otherwise compensable accident, there may exist a reasonable basis for denial of the claim. In the alternative, if there is no reason to suspect the injury did not meet all five elements required by O.C.G.A. § 34-9-266, then providing the claimant medical treatment, likely including a hernia repair surgery, as quickly as possible may be the best course of action.
Attorney Contact Info
Sara Phillips
sara.phillips@swiftcurrie.com
404.888.6134