Insurer Must Pay Damages Not Covered By Workers’ Compensation, Georgia Court Of Appeals Says

November 3, 2017 - 4:41 pm

            The Georgia Court of Appeals agreed with a trial judge that an insurer must pay $100,000 in uninsured /underinsured motorist coverage to a car wreck victim, even though workers’ compensation had already paid him nearly twice that. Although the injured man did receive workers’ comp benefits for his injuries and some lost wages, that amount didn’t cover the full extent of his lost wages from the accident.

            The underlying case involved a two-car accident resulting in a suit by Jerry Rockefeller against Deborah Orso in DeKalb County State Court. Orso had $25,000 in coverage, which her insurer paid to settle the claims against her. Because Rockefeller was working when the accident happened, he was covered under the Workers; Compensation Act, and he received benefits of $197,966 for his injuries. His workers’ compensation award also included weekly payments for lost wages, but they were below his regular pay sale, leaving him more than $183,000 in short of what he would have earned.

            Rockefeller had a total of $100,000 Uninsured Motorist coverage with Farm Bureau. The policy contained a provision stating that the “limit of liability” was to be reduced by any sums paid by workers’ comp. The insurer sought to pay Rockefeller none arguing that because the workers’ comp benefits Rockefeller received exceeded the total Uninsured Motorist coverage. The state trial court ruled in favor of Rockefeller ordering Farm Bureau to pay the full $100,000 for uncompensated damages not covered by the Orso settlement or workers’ comp award.

The insurer appealed the state court’s judgment. The Georgia Court of Appeals upheld the state court’s decision and held that the text of Georgia’s UM insurance law only allows such a carrier to deny coverage for damages for which the insured has been compensated. The court noted that Rockefeller was seeking only uncompensated losses up to the UM policy limit, which included compensation for which he hadn’t received, such was future medical expenses, future lost earning, and past and future pain and suffering. Finally the court held that the terms of limitation of liability provisions in Rockefeller’s UM policy, although would support the insurer seeks, is not authorized by the UM statute and cannot b enforced as written.

The case sends a warning signal to property and casualty insurers in Georgia that regularly try to avoid their liability under coverage policy. Undoubtedly, this case provides meaningful impact to injured workers, whose rights would be adequately protected.

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