O.C.G.A.

O.C.G.A. § 34-9-360 (2019)

Reimbursement of employer or insurer for subsequent injury compensation payments; amounts of and prerequisites to reimbursement from fund

✓ O.C.G.A. — 2019 edition (Public.Resource.Org Release 73)
Code text and O.C.G.A. statutory annotations on this page reflect the 2019 Official Code of Georgia Annotated (Public.Resource.Org Release 73, 2019-08-21; public domain per Georgia v. Public.Resource.Org, 2020). The Syfert case-law annotations in Notes of Decisions, below, are current.
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(a) If an employee who has a permanent impairment incurs a subsequent injury or disease arising out of and in the course of employment, which subsequent injury results in liability for the disability arising from merger of the subsequent injury with the preexisting permanent impairment, the employer or insurer shall in the first instance pay all compensation provided by this chapter. The employer or insurer shall be reimbursed from the Subsequent Injury Trust Fund for all weekly income benefits payments payable after 104 weeks of payment. (b) An employer or insurer who has paid medical and rehabilitation expenses on behalf of the employee who comes under this article shall be entitled to reimbursement from the fund on the following basis: (1) Fifty percent reimbursement of all medical and rehabilitation expenses which exceed $5,000.00 but do not exceed $10,000.00; (2) One hundred percent reimbursement of all medical and rehabilitation expenses paid which exceed $10,000.00. (c) As a prerequisite to reimbursement from the fund, the insurer shall be required to certify that the medical and indemnity reserves have been reduced to the threshold limits of reimbursement. (d) When the same employer in a claim accepted by the fund for reimbursement returns the injured worker to work with the same

employer, the employer shall not be subject to further indemnity or medical deductibles in the event the employee suffers a new accident that merges with the same prior impairment that previously resulted in fund acceptance of the prior reimbursement claim. This provision does not apply if the employee returns to work for a different employer or there has been a break in service by the employee. (e) As a prerequisite to reimbursement from the fund, there must be evidence of payment of workers’ compensation benefits in accordance with Code Section 34-9-221 or an award of the State Board of Workers’ Compensation directing the employer to pay weekly income benefits as a result of the subsequent injury. (f ) The fund shall reimburse only those indemnity, medical, and rehabilitation expenses that the employer or insurer was legally obligated to pay to the employee or claimant. The fund shall reimburse such expenses at a rate not exceeding the usual and customary charges. The administrator of the fund may refer any medical or rehabilitation expense to the State Board of Workers’ Compensation for review and recommendation and, in the event of a dispute between the fund and the employer or insurer, the questioned medical and rehabilitation expense shall be referred to the State Board of Workers’ Compensation for approval. This subsection shall apply to any claim filed against the fund on and after July 1, 1987.

History

(Code 1933, § 114-912, enacted by Ga. L. 1977, p. 608, § 1; Ga. L. 1985, p. 1426, § 4; Ga. L. 1987, p. 820, § 1.)

Annotations

Cross references. - Consideration given to this Code section whenever an experience modification factor is applied to the premium of an employer’s policy of workers’ compensation insurance,

§ 34-9-137. Employee’s right to benefits upon sustaining of injury which merges with prior injury to produce total disability, § 34-9-241.

JUDICIAL DECISIONS Cited in Georgia Subsequent Injury Trust Fund v. Consolidated Freightways,

Inc., 224 Ga. App. 899, 482 S.E.2d 508 (1997).

Notes of Decisions
Cited in 4 cases, 1995–1997 · leading case: Georgia Subsequent Injury Trust Fund v. Muscogee Iron Works, 462 S.E.2d 367 (Ga. 1995).
Georgia Subsequent Injury Trust Fund v. Muscogee Iron Works, 462 S.E.2d 367 (Ga. 1995). · cites it 2× “The Fund was a party to a proceeding for reimbursement of workers’ compensation benefits initiated pursuant to OCGA § 34-9-360. Accordingly, unless there is statutory authority for the award of attorney’s fees against a party to such a proceeding for reimbursement, the award of…”
Altermatts Painting v. Subsequent Injury Trust Fund, 464 S.E.2d 922 (Ga. Ct. App. 1995). · cites it 6× “OCGA § 34-9-360. Reimbursement is based on payment of workers’ compensation benefits in accordance with OCGA § 34-9-221 or a Board award, and the Fund is to reimburse only certain weekly income benefits and a prescribed portion of “only those indemnity, medical, and…”
Muscogee Iron Works v. Ward, 455 S.E.2d 363 (Ga. Ct. App. 1995). · cites it 2× “; OCGA § 34-9-360 (a), (b). When Muscogee applied for reimbursement from the Fund, however, the Fund defended the claim.”
Georgia Subsequent Injury Trust Fund v. Consol. Freightways, Inc., 482 S.E.2d 508 (Ga. Ct. App. 1997). · cites it 4× “The trial court reasoned that as OCGA § 34-9-360 (e) required evidence of payment of weekly income benefits or an award of the Board as a prerequisite to reimbursement from the Fund, Consolidated had 78 weeks from the date of the Board’s ruling to make a timely claim.”
Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.