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Georgia Court of Appeals says, A Third Party Insurer Must Pay Damages Not Covered by Workers’ Compensation

The Georgia Court of Appeals agreed with a trial judge that the third party insurer must pay $100,000 in uninsured/underinsured motorist coverage to an injured worker involved in a car accident, even though the injured worker had already received double that amount from the workers’ comp Insurer.

The injured worker received workers’ comp benefits and some lost wages, but the amount didn’t cover the full extent of the lost wages from the accident.

As detailed in the appeals court opinion, the underlying case involved a two-car accident in which the employee, Jerry Rockefeller, filed suit against the other driver, Deborah Orso, in DeKalb County State Court.

The insurer for Orso paid $25,000 to Rockefeller in a settlement of his claim.

Additionally, since Rockefeller was working during the time of the accident, he was protected under the Workers’ Compensation Act. He received benefits for his injuries in the amount of $197,966.55. And, even though the workers’ compensation award provided weekly benefits the amount was less than the wages Rockefeller was earning at the time of the accident, leaving him with lost wages totaling $183,022.38 for which the insured worker was not compensated.

Rockefeller sought additional compensation under four UM policies he had with Georgia Farm Bureau which were in effect during the time of the accident. Each policy had up to $25,000 in uninsured motorist benefits, combined amount of $100,000. Each policy contained a provision stating that the “limit of liability” was to be reduced by any sums paid for bodily injury under workers’ compensation.

The insurer filed a motion for summary judgment, “arguing that the amount of the workers’ compensation benefits Rockefeller received exceeded the combined coverage of his UM policies, Georgia Farm Bureau’s liability to Rockefeller under the UM policies was reduced to zero.” Rockefeller then filed his own motion for partial summary judgment, “arguing that his UM policies should cover up to $100,000 of his uncompensated damages, to include lost wages, damages for past and future pain and suffering, and for future medical expenses that were not covered by his settlement with the other driver’s insurer or his workers’ compensation award.” The judge denied the Insurer’s motion and granted Rockefeller’s motion for partial summary judgment.

The Insurer then appealed the decision, but it was then upheld by the Georgia Court of Appeals, which held that the text of Georgia’s UM insurance law only allows such a carrier to deny coverage for damages for which the insurer has been compensated.

The injured worker was only seeking uncompensated losses up to the UM policy limit, including compensation not yet received, such as future medical expenses, future lost earnings, and past and future pain and suffering. Lastly, the court held that the terms of the limitation of liability provisions in the injured worker’s UM policy is not authorized by the UM statute and can’t be enforced as written.  This case sends a warning to third party insurers in Georgia that try to avoid their liability under coverage policies.

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