American International Adjusting Co. v. Davis

414 S.E.2d 292, 202 Ga. App. 276, 1991 Ga. App. LEXIS 1748
CourtCourt of Appeals of Georgia
DecidedDecember 3, 1991
DocketA91A0831
StatusPublished
Cited by5 cases

This text of 414 S.E.2d 292 (American International Adjusting Co. v. Davis) is published on Counsel Stack Legal Research, covering Court of Appeals of Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
American International Adjusting Co. v. Davis, 414 S.E.2d 292, 202 Ga. App. 276, 1991 Ga. App. LEXIS 1748 (Ga. Ct. App. 1991).

Opinion

Cooper, Judge.

In August 1988, appellee was examined by Dr. Don Robinson, a pulmonary disease specialist, after experiencing chest pains and difficulty in breathing. Appellee was exposed to kaolin dust in the course of his employment and stopped working on September 3, 1988. After a series of tests, Dr. Robinson advised appellee, on September 9, 1988, that in his opinion, appellee contracted work-related pneumoconiosis and was totally disabled. Appellee then informed his employer that he would be out of work. The personnel clerk with responsibility for administering group health benefit plans provided appellee with the paperwork necessary for coverage, which appellee completed and returned on October 14, 1988, along with a statement from Dr. Robinson reporting his diagnosis. Shortly thereafter, appellee began receiving group disability benefits. The employer referred appellee to Dr. William Rawlings for a second opinion, and after examining appellee on October 14, 1988, Dr. Rawlings confirmed the kaolin pneumoconiosis diagnosis but concluded that appellee was not totally disabled and could work at tasks free from kaolin exposure. On October 17, 1988, Dr. Rawlings advised the employer’s nurse that appellee be given tasks with mild or moderate activity free from exposure to kaolin dust. On October 27, 1988, appellee retained legal counsel for assistance in making a claim for workers’ compensation benefits. Beginning on November 3, 1988 until January 9, 1989, appellee saw Dr. Ram Puri, who agreed that appellee was totally disabled, but Dr. Puri also concluded that appellee could work in another area away from kaolin dust. The employer filed its first report of injury and notice to controvert payment of compensation with the board on December 2, 1988, and the following day, counsel for appellee notified the em *277 ployer of his representation of appellee and requested medical records. On October 4, 1989, appellee filed a claim for workers’ compensation benefits with the board. An attorney fee contract submitted to the ALJ revealed that appellee had new counsel who began working for appellee on October 2, 1989.

Appellants, the employer and its insurer, moved for a dismissal of appellee’s claim on the ground that the claim was time-barred. After conducting a hearing, the ALJ granted the motion, and appellee appealed to the full board. The full board adopted the ALJ’s findings of fact and conclusions of law, and the case was appealed to the superior court where it was reversed. We granted appellants’ application for discretionary appeal to determine whether the trial court erred in reversing the board’s dismissal of appellee’s claim for benefits.

1. In their first five enumerations of error, appellants contend the superior court committed legal error and acted in excess of its authority in reversing the ruling of the board that appellee’s claim was time-barred by OCGA § 34-9-281 (b) (2) and in determining that OCGA § 34-9-82 (a) was the applicable statute of limitation.

(a) In its order, the superior court ignored the determination of the board that OCGA § 34-9-281 (b) (2) was the applicable statute of limitation and declared that OCGA § 34-9-82 (a) controlled. However, implicit in the board’s adoption of the former statute as the applicable statute of limitation was its determination that appellee’s pneumoconiosis satisfied the statutory definition of an occupational disease which is “[a disease] which arise[s] out of and in the course of the particular trade, occupation, process, or employment in which the employee is exposed to such disease, provided the [following is proven]: (A) A direct causal connection between the conditions under which the work is performed and the disease; (B) That the disease followed as a natural incident of exposure by reason of the employment; (C) That the disease is not of a character to which the employee may have had substantial exposure outside of the employment; (D) That the disease is not an ordinary disease of life to which the general public is exposed; (E) That the disease must appear to have had its origin in a risk connected with the employment and to have flowed from that source as a natural consequence.” OCGA § 34-9-280 (2). A review of the record shows that there was ample evidence to support the determination that appellee’s pneumoconiosis was an occupational disease; therefore, the specific statute of limitation applicable to occupational diseases as set forth in OCGA § 34-9-281 (b) (2) should control, instead of the statute generally applicable to compensable injuries found in OCGA p 34-9-82 (a). “ ‘(T)he findings (of the board) are conclusive and binding (OCGA § 34-9-105 (c)) and neither the superior court nor this court has any authority to substitute itself as a fact finding body in lieu of the Board.’ [Cits.] The superior court, *278 when sitting as an appellate body, is bound by the ‘any evidence’ standard of review and is not authorized to substitute its judgment as to weight and credibility of the witnesses. [Cit.]” Maddox v. Elbert County Chamber of Commerce, 191 Ga. App. 478 (1) (b, c) (382 SE2d 150) (1989). By adopting OCGA § 34-9-82 (a) and ignoring the Board’s determination, the superior court became a factfinding body, substituting its own judgment of the evidence for the judgment of the Board.

OCGA § 34-9-281 (b) (2) provides, in pertinent part, “an employer shall be liable for compensation under this article only where . . . [t]he claim for disablement is filed within one year after the date the employee knew or, in the exercise of reasonable diligence, should have known of the disablement and its relationship to the employment. . . .” (Emphasis supplied.) The record establishes, by appellee’s own testimony, that on September 9, 1988, Dr. Robinson informed him that he had contracted pneumoconiosis due to exposure to kaolin dust at work. Therefore, appellee’s claim should have been filed within one year of September 9, 1988, and his filing on October 4, 1989 was beyond the statutory period. Appellee is incorrect in his contention that he should not be charged with knowledge of his disability until Dr. Rawlings provided the second opinion because this opinion, rendered at the behest of the employer, provided notice of his disability to the employer. The focus of the statute is on the employee’s knowledge. Moreover, Dr. Rawlings’ opinion served to confirm Dr. Robinson’s initial diagnosis. Hence, under the “any evidence” rule, the Board was correct in dismissing the claim as time-barred.

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Bluebook (online)
414 S.E.2d 292, 202 Ga. App. 276, 1991 Ga. App. LEXIS 1748, Counsel Stack Legal Research, https://law.counselstack.com/opinion/american-international-adjusting-co-v-davis-gactapp-1991.