Georgia Case Study: Employer Must Pay For Injured Worker's Attorney Fees

Introduction

Normally, a workers’ comp lawyer earns a 25 percent fee on the benefits awarded to the injured worker. However, if the employer’s defense is found to be unreasonable, the employer may be ordered to pay an additional attorney fee as a penalty. This case illustrates how Georgia law protects injured workers from unreasonable conduct by employers and their insurers. In this case, the employer denied a claim based on an idiopathic injury theory, arguing that the employee’s fall was not work-related. The Administrative Law Judge (ALJ) found that the employer’s defense was unreasonable and ordered them to pay the employee’s attorney fees.

We’ll summarize the facts, explain what qualifies as an unreasonable defense under Georgia law, analyze why the defense in this case was deemed unreasonable (and how it delayed the worker’s medical care). Ultimately, the employer was ordered to pay an assesed attorney fee award of $3,250 to the claimant’s attorney. This case illustrates the importance of reasonable conduct in workers’ compensation claims and the consequences for employers who fail to meet that standard.

You can read the full decision by clicking here.

Summary of the Facts: The Spider and the Tires

An employee was injured on the job while stacking or organizing tires in his workplace. As he was handling the tires, a spider suddenly crawled out, startling him. Instinctively, the worker jumped back in fear – a reaction that unfortunately caused him to trip and suffer a physical injury . He immediately reported the incident, explaining that the spider’s appearance caused his abrupt movement and injury. The employer, however, denied the workers’ comp claim. Their reasoning? They asserted that the injury was “idiopathic” – essentially arguing that the accident was personal to the employee or had no particular connection to his work. In workers’ compensation terms, an idiopathic injury is one that happens at work but stems from an unknown or personal cause, not a work condition. In Georgia, if an injury “occurred at the workplace but happened due to either an unknown cause or for reasons that are personal to the injured worker,” it is considered idiopathic and not compensable. The employer claimed the worker’s fall was not caused by any work-related hazard, but by a personal reaction (fear of a spider), thus attempting to avoid liability.

The Judge heard the claim at a workers’ compensation hearing. The evidence showed that the spider emerged from the tires the employee was working with, directly leading to the injury. The employee had no pre-existing condition or purely personal health issue that caused him to fall – it was the unexpected spider (a creature in the work environment) that triggered the accident. The employer did not present any credible evidence to contradict this chain of events. Despite this, the employer and its insurer continued to deny the claim on the idiopathic-ground theory, forcing the case to litigation and delaying the employee’s access to medical treatment while the dispute lingered.

What Is an “Unreasonable Defense” under O.C.G.A. §34-9-108?

Georgia’s workers’ compensation law contains a specific provision to discourage frivolous or groundless defenses. O.C.G.A. § 34-9-108(b)(1) provides that “[u]pon a determination that proceedings have been brought, prosecuted, or defended in whole or in part without reasonable grounds, the administrative law judge or the board may assess the adverse attorney’s fee against the offending party.” In simpler terms, if an employer (or an insurer) fights a workers’ comp claim without a reasonable basis, the ALJ or the State Board’s Appellate Division can order that party to pay the other side’s attorney fees. This is often called an “assessed attorney fee” or fee penalty, and it’s meant to penalize unreasonable conduct and compensate the injured worker’s attorney for the extra time spent overcoming a baseless defense.

Importantly, not every lost defense is “unreasonable” under the law. Georgia courts have long held that the determination of unreasonable defense is a question of fact for the Board or judge. If the claim was “closely contested on reasonable grounds,” then attorney fees should not be awarded. In other words, an employer is allowed to challenge a claim if they have some legitimate evidence or an arguable legal basis – the law doesn’t punish mere disagreement or requiring proof. In fact, even if the employer ultimately loses, they won’t be hit with attorney fees so long as there was any evidence supporting a reasonable defense position. This principle was highlighted in cases like Pet, Inc. v. Ward, where the Georgia Court of Appeals noted that fees aren’t appropriate if the employer’s defense, though unsuccessful, had some merit or evidentiary support. Likewise, in L& S Construction v. Lopez (Ga. Ct. App. 2007), the court reversed an attorney-fee award from the Superior Court because there was “some testimony” that gave the employer a reasonable basis to contest the claim – meaning the defense was not wholly groundless.

Conversely, an “unreasonable defense” is essentially one that lacks any reasonable foundation – factual or legal. It could mean the employer denied a claim without investigating, or ignored uncontradicted evidence of a work injury, or asserted a defense that is contrary to well-settled law. In those instances, the employer/insurer is considered to be acting in bad faith or without the diligence the law expects. O.C.G.A. §34-9-108 is there to deter this behavior. The statute not only allows assessment of attorney fees, but also permits the ALJ/Board to award reasonable litigation expenses (like costs for expert witnesses, depositions, etc.) if a party defends a claim without reasonable grounds. Any such fee or expense award comes in addition to the underlying compensation benefits owed to the employee – it does not cut into the injured worker’s medical or indemnity benefits. In summary, the law tries to ensure that an injured worker (and their attorney) aren’t financially hurt by having to fight against a baseless denial of benefits.

No Legitimate Basis in Fact

The employer labeled the injury “idiopathic,” implying it was personal to the employee or had no work cause. Yet the facts clearly showed a direct work connection – the employee was performing his job (organizing stock tires) when a workplace hazard (a spider hidden in those tires) caused him to react and get hurt. This was not an unexplained collapse or a purely personal medical event like a seizure or fainting spell. The cause of injury was identified and it originated from the work environment. By definition, an idiopathic claim is one stemming from an unknown or personal cause unrelated to the job. That simply did not apply here. The employer had no evidence that the injury was due to a personal condition (for example, they had no medical evidence that the worker had a balance disorder or health issue that caused a fall). All evidence indicated an ordinary person could have been startled by that spider. In short, there were no reasonable grounds to classify this as an idiopathic (non-work) injury – the classification was factually wrong.

Contrary to Established Law

Georgia law requires that an injury “arise out of” the employment to be compensable, meaning there must be a causal connection between the work conditions and the accident. Here, the causal connection was obvious: handling tires at work exposed the employee to spiders (a risk associated with that environment), and that risk materialized and caused injury. Past Georgia decisions have shown that if a risk is equally present in non-employment life (like a purely unexplained fall with no work hazard), the claim can be denied as not arising out of employment. However, when a work condition does contribute – e.g. a foreign object causing a startle or a slip – the injury is generally compensable. By insisting this accident was not work-related in the face of clear evidence to the contrary, the employer was effectively ignoring the legal standard. This wasn’t a gray area of law; it was a straightforward application of the “arising out of employment” test. Thus, the defense was not only factually unsupported but also at odds with well-settled workers’ comp principles.

Delay of Needed Medical Treatment

One significant consequence of the employer’s unreasonable denial was the delay in the employee’s medical care. Under workers’ compensation, when a claim is denied or disputed, employers/insurers often halt benefits – including payment for medical treatment – until the dispute is resolved. In this case, because the employer persisted in fighting the claim, the injured worker likely did not receive authorized medical treatment promptly for his injury. He may have had to postpone surgery, therapy, or other care while waiting for a trial and appeal to vindicate his rights. The ALJ specifically noted how the employer’s baseless defense harmed the employee by postponing necessary care that should have been provided immediately. This delay not only prolonged the worker’s pain and recovery time but also went against the humanitarian purpose of the Workers’ Compensation Act (which is to provide relatively swift benefits without protracted litigation). The ALJ found it particularly egregious that, without any good reason, the employer’s stance kept the worker from getting treatment for the injury that occurred on the job. This real-world impact underscored the unreasonableness of the defense – it was not a harmless technical argument, but one that materially hurt the claimant.

The ALJ concluded that the employer/insurer had defended the claim “in whole or in part without reasonable grounds”

In this case, the lack of evidence for the idiopathic claim made it a textbook example of an unreasonable defense. The Appellate Division, upon the employer’s appeal, affirmed the ALJ’s findings. The Appellate Division is authorized to review the evidence and even substitute its own findings if warranted. In this instance, they agreed that the evidence was overwhelmingly in the employee’s favor – enough that the employer never should have fought the claim. There was simply no “reasonable ground” to deny that the spider-startle injury arose out of the employment. Thus, the defense was deemed unreasonable at both the trial level and on Board appeal.

Paid by the Employer, Not Deducted from the Worker’s Benefits: Crucially, the assessed $3,250 attorney fee was ordered in addition to the worker’s compensation benefits, not out of them. The employee still received (or will receive) all the medical care and income benefits awarded for the injury. The $3,250 is extra, paid by the employer/insurer as a penalty. This ensures that the worker’s recovery isn’t reduced by having to pay his attorney – the very point of §34-9-108(b)(1) is to make the offending party bear that cost. From the employee’s perspective, this makes him whole. He gets his benefits and his attorney is compensated separately for the ordeal of fighting an unjust denial.

If your workers’ comp claim has been unreasonably denied, Bourne Law Firm can help

Bourne Law Firm is dedicated to protecting the rights of injured workers in Georgia. If you’ve been hurt on the job and your claim has been denied or delayed, we can help. Our experienced attorneys understand the complexities of workers’ compensation law and know how to fight back against unreasonable defenses. Call us today at 770-886-3030 to get started.