Zurich American Insurance v. Dicks

470 S.E.2d 279, 220 Ga. App. 725, 96 Fulton County D. Rep. 1356, 1996 Ga. App. LEXIS 325
CourtCourt of Appeals of Georgia
DecidedMarch 15, 1996
DocketA95A1861
StatusPublished
Cited by6 cases

This text of 470 S.E.2d 279 (Zurich American Insurance v. Dicks) 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
Zurich American Insurance v. Dicks, 470 S.E.2d 279, 220 Ga. App. 725, 96 Fulton County D. Rep. 1356, 1996 Ga. App. LEXIS 325 (Ga. Ct. App. 1996).

Opinions

Beasley, Chief Judge.

June Dicks sued Zurich American Insurance Company, her for[726]*726mer employer’s workers’ compensation insurer. Dicks suffered a work-related injury and filed a complaint, sounding in tort, alleging that Zurich intentionally and wrongfully terminated her medical benefits, thereby aggravating her injuries. Zurich moved for summary judgment on the ground that Dicks’ complaint was barred by the exclusive remedy provision of the Workers’ Compensation Act. The trial court denied the motion, and we granted Zurich’s application for interlocutory appeal.

The facts are not disputed. On September 26, 1990, Dicks suffered a work-related injury, and Zurich authorized medical treatment. Dicks’ treating physician ordered her not to return to work until he released her to do so. On June 21 of the following year, Zurich ordered Dicks to be examined by Dr. Basil Griffin, Jr., who was not one of her treating physicians. Dr. Griffin concluded that Dicks “should be either terminated from her job or put in a work hardening program where she can get back to work. . . Apparently following Dr. Griffin’s advice, Dicks’ employer suspended medical benefits and terminated her from her job on August 29. As a result of the suspension of benefits, Dicks on October 21 ceased physical therapy which had been ordered by her treating physician. She resumed treatment 71 days later, but in the opinion of her treating physician, “the more than two-month-long delay in treatment exacerbated [her] medical condition, greatly worsened her symptoms, adversely affected her ability to be rehabilitated, caused additional pain behavior and substantially affected her permanent partial impairment rating.”

The ALJ ordered that all benefits be restored to Dicks effective August 29, and upon finding that Zurich’s defense of the claim was unreasonable, awarded attorney fees under OCGA § 34-9-108 (b) (2).

The sole issue is whether Dicks’ common law claim against Zurich is barred by the exclusive remedy provision of the Act.

OCGA § 34-9-11 (a) provides in part that “[t]he rights and the remedies granted to an employee by this chapter shall exclude all other rights and remedies of such employee ... at common law or otherwise, on account of such injury, loss of service, or death. . . .” Not all employee claims against employers for intentional injuries are barred by OCGA § 34-9-11 (a). An insurer might be held liable for certain egregious torts, as pointed out in 8 ALR4th 902, 905 (1981). But where the Act provides a penalty for delayed benefit payments, a claim based on the delay is barred by the exclusive remedy provision.

In Bright v. Nimmo, 253 Ga. 378, 381 (320 SE2d 365) (1984), the Supreme Court held that the intentional delay of workers’ compensation payments does not give rise to an independent cause of action against the employer or its insurer for financial injury. It expressly left open the question of whether the employee could recover in tort for “an alleged intentional physical injury by the employer.” Id. What [727]*727clearly is foreclosed is additional recovery for the delay itself in making the monetary payments. The reason given by the court is that the Workers’ Compensation Act provides penalties for delay, so the exclusivity feature of the Act excludes the employee’s use of common law remedies to obtain penalties in addition to the “delinquency charge” and attorney fees provided for in the Act.

In Aetna Cas. &c. Co. v. Davis, 253 Ga. 376 (320 SE2d 368) (1984), an employee sued her employer’s workers’ compensation insurer for tortious breach of contract alleging that the insurer breached a board-approved settlement agreement by failing to pay medical benefits awarded under the agreement. Relying on Bright, supra, decided the same day as Davis, the Supreme Court acknowledged that OCGA § 34-9-108 provides for the assessment of attorney fees against a party who unreasonably controverts medical payments. It ruled that “the employee’s use of common law remedies [was therefore] excluded.” Davis, supra at 378.

Distinguishable is Jim Walter Homes v. Roberts, 196 Ga. App. 618 (396 SE2d 787) (1990), cert. denied, 196 Ga. App. 908. The plaintiff suffered a work-related injury and sued her former employer and its workers’ compensation insurer, alleging that they intentionally and wrongfully refused to authorize payment for necessary medical treatment. The court entered judgment against the employer, who on appeal attacked the trial court’s jurisdiction to consider a workers’ compensation claim and the validity of the judgment under the Act’s exclusive remedy provision. Citing Murphy v. ARA Svcs., 164 Ga. App. 859 (298 SE2d 528) (1982) and Cox v. Brazo, 165 Ga. App. 888 (303 SE2d 71) (1983), we found that the alleged injury was “an intentional physical injury resulting from [the employer’s] refusal to authorize necessary treatment ...” and concluded that the complaint set forth a common law cause of action which was not barred by the Act’s exclusive remedy provision. Roberts, supra at 621.

In both Murphy and Cox, an employee sued her employer after being sexually harassed by a supervisor. In both cases, the employee alleged that her employer negligently retained the supervisor, despite repeated complaints of harassment, and in both cases the trial court granted the employers summary judgment, finding that the employees’ claims were barred by the Act’s exclusive remedy provisions. In Murphy, this Court concluded that the injuries involved in that case did not fall within the Act’s definition of “injury,” and the claim thus was “neither covered nor barred by the Workers’ Compensation Act.” Id. at 863. A similar conclusion was reached in Cox, supra at 889.

In her complaint, employee Dicks alleged that the ALJ and board found that defendant insurer’s cessation of benefits was “unconscionable.” She also alleged that defendant’s acts constituted “willful and wanton misconduct and misfeasance” and that its “unlawful contro[728]*728version of [her] benefits was willful, intentional, [and] with conscious disregard of the consequences.” This comprises the alleged breach of legal duty for which the plaintiff seeks tort damages. She had already obtained against the employer and insurer attorney fees in an amount equal to one-third of the recovery of benefits, as a penalty under OCGA § 34-9-108 (b) for their acting “without reasonable grounds.” This, and the delinquency charges based on a percentage of benefits, which are allowed by OCGA § 34-9-221 (e) and (f), are the only penalties provided under the Workers’ Compensation Act for employer/ insurer recalcitrance.

The Act does not contemplate physical injury flowing from and being caused by wilful and wanton misconduct of an insurer in refusing to make payments. Of course, any refusal to pay would be “intentional.” It is the nature

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Zurich American Insurance v. Dicks
470 S.E.2d 279 (Court of Appeals of Georgia, 1996)

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Bluebook (online)
470 S.E.2d 279, 220 Ga. App. 725, 96 Fulton County D. Rep. 1356, 1996 Ga. App. LEXIS 325, Counsel Stack Legal Research, https://law.counselstack.com/opinion/zurich-american-insurance-v-dicks-gactapp-1996.