The Rycroft Defense and the Power of a Medical Questionnaire
By: Spenser West
In Georgia Electric Co. v. Rycroft, 259 Ga. 155, 378 S.E.2d 111, the claimant applied for a job with Georgia Electric Co. and completed a written application that included a questionnaire of the employee’s medical history. The questions regarding the prospective employee’s medical history attempted to solicit information about potential prior back injuries, workers’ compensation claims, past disability benefits, prior surgeries or surgical recommendations and any lost time due to illness or injury. Despite undergoing a lumbar fusion as part of a prior workers’ compensation claim, the claimant answered “no” to all questions, denying any pertinent medical history.
While later working for the employer, the claimant fell, re-fractured his low back and filed a workers’ compensation claim. On review, the Supreme Court of Georgia determined a test must be used to protect employers from fraud in such situations when they rely on the “willful misrepresentation” of an employee’s physical condition.
Under the Rycroft defense, when an employee intentionally misrepresents his physical condition, all three elements below must be present in order to bar recovery of workers’ compensation benefits in Georgia. The three elements of what is called the “Larson” test include:
- The employee must have knowingly and willfully made a false representation as to his physical condition.
- The employer must have relied upon the false representation and this reliance must have been a substantial factor in the hiring.
- There must have been a causal connection between the false representation and the injury.
To digest these elements further, let us examine the first element and how to determine if a claimant knowingly and willfully makes a false representation as to his physical condition. To meet this element, there must be knowledge of a prior injury. Also, the employee must have misled the employer as to his physical condition. In Rycroft, the claimant willfully made a false representation on the questionnaire when he answered “no” to the questions asking about any prior back injuries. The employer provided evidence the claimant had a prior lumbar fusion surgery and a workers’ compensation claim filed based on that lumbar spine injury, making it clear Mr. Rycroft knowingly and willfully made a false representation. This seems straightforward, but problems can arise when an employer is not able to prove the false representation. That is why it is important to utilize a medical questionnaire.
The second element addresses the employer’s reliance upon the claimant’s false representation. An employer must show it relied on the claimant’s statements as to physical condition (or the lack of any pertinent physical condition or prior injuries) and that such reliance was a substantial factor in the hiring process. In Rycroft, the employer met this element based on the questions in their medical questionnaire. They also interviewed Mr. Rycroft and questioned him about any prior back injuries, which he continued to deny. The court found Georgia Electric’s reliance on the claimant’s statements about his physical condition was a substantial factor because of its questionnaire and subsequent interview.
The employer may have a problem proving reliance on the misrepresented condition if the claimant had disclosed other serious medical conditions, such as a torn knee or shoulder ligament. When that occurs, doubts may arise as to whether the claimant’s physical condition was a substantial factor in the hiring process. An administrative law judge (ALJ) could find the employer did not meet this element as the claimant disclosed two serious medical conditions, but failed to disclose a third, when applying for a heavy-duty construction position.
The third element of the Rycroft defense provides that an employer need only prove there is a causal connection between the misrepresented condition and the subsequent on-the-job injury. The employer cannot just assert the claimant would not have been hired had the claimant not misrepresented his injury. If that were the case, and if the second prong were met, the third prong would be as well, but that is not how this element is applied. The causal connection is not to the employment, the connection is to the subsequent injury.
For example, in Rycroft, the employee was holding onto something and slipped. He fell onto his back and injured his spine at the same place where he previously had an undisclosed spinal fusion surgery. The court found Mr. Rycroft’s subsequent injury exists because his spinal cord was compromised and therefore unable to handle the fall he sustained. Thus, the “causally connected” test examines whether the claimant would have likely not been injured had his pre-existing condition not been present. An additional problem arises when the prior injury is deemed to not be causally related to the subsequent injury by the authorized treating physician (ATP). This typically arises with knee injuries where the knee was repaired and completely resolved. In order to combat this, you must obtain medical evidence the claimant was previously treating for his prior injury or that he continued to have symptoms.
There are benefits to utilizing medical questionnaires in this fashion. They can be an effective tool and strategy for not only mitigating the number of workers’ compensation claims filed, but defending such claims where the employer can prove the aforementioned elements.
Attorney Contact Info
Spenser West
spenser.west@swiftcurrie.com
404.888.6208