Workers’ compensation is an insurance program that guarantees payment of medical benefits and a portion of weekly earnings to employees who are injured while working. Every employer in Georgia that has three or more employees is required by law to provide workers’ compensation insurance for its workers. Workers’ compensation is a no-fault insurance system. In a no-fault system, you are covered if you were hurt on the job, and you do not have to prove fault on the part of the employer to recover. Since it is a no fault system, the employee cannot sue its employer for negligence for on-the-job injuries. However, a claim and lawsuit may be asserted against third-parties (ie: individuals and companies who are not your co-workers or employer) who caused your injury. Such claims are called “third-party liability” claims and may be pursued simultaneously with a workers’ compensation claim.
Workers’ Compensation Benefits
Depending on the nature of your injury, you will receive one of four basic workers’ compensation income benefits:
Temporary Total Disability Benefits (TTD) — This workers’ compensation benefit is paid weekly to injured workers who are unable to return to any type of work after an on-the-job injury. These benefits amount to two-thirds of the employee's average weekly wage, up to a limit of $500 per week. People with non-catastrophic injuries are limited to 400 weeks of benefits. People with catastrophic injuries receive workers’ compensation benefits for an unlimited time period.
Temporary Partial Disability Benefits (TPD) — This workers’ compensation benefit is paid weekly to an employee who returns to work in a job paying less as a result of an on-the-job accident. Benefits are two-thirds of the difference between the employee's average weekly wage before and after the injury, up to a certain limit. These workers’ compensation benefits are paid for up to 350 weeks.
Permanent Partial Disability (PPD) — This workers’ compensation benefit is paid weekly to an employee whose on-the-job injury results in a permanent disability. Your doctor will use AMA guidelines to determine your percentage of disability. Payment is based on the following formula: your percent of disability times the number of weeks the State Workers' Compensation Board assigns to this percent of disability times the Temporary Total Disability rate.
Death Benefits — This benefit is available to the dependent spouse and minor children of an employee who died due to on-the-job injuries. This workers’ compensation benefit is payable at the rate of two-thirds of the deceased employee's average weekly wage at the time of the accident, up to a maximum of $500 per week. Funeral expenses are currently paid up to $7,500. In total, a widowed spouse with no children will be paid no more than a $150,000 total in weekly payments. A dependent child of a deceased worker is eligible to receive weekly payments through workers’ compensation until he or she reaches age 18.
Medical Benefits — Medical and rehabilitation treatment are covered by workers' compensation, but all treatment — except immediate emergency care — must be provided by a physician that is included on the employers' panel of approved workers’ compensation physicians.
Workplace injuries are classified as catastrophic or non-catastrophic for purposes of workers' compensation. Catastrophic injuries are those involving:
- Severe paralysis
- Severe head injures
- Severe burns
- Other severe injuries that prevent you from being able to perform your prior work or another job for any employer
Workers' compensation will pay two-thirds of your average weekly wage, up to a maximum of $500 per week, for as long as you are unable to return to work. Medical and vocational rehabilitation workers’ compensation benefits are also covered.
Workplace Wrongful Death
According to the Bureau of Labor Statistics, 5,703 people died in workplace accidents in America during 2006, including 192 people in Georgia. The survivors of those who died because of on-the-job accidents or injuries cannot sue their deceased loved one's employer for damages. They can, however, receive death workers’ compensation benefits through the employer's workers' compensation insurance.
A sole surviving spouse of a worker who dies in a workplace accident will receive burial expenses of up to $7,500 and two-thirds of the average weekly wage of the deceased worker up to a maximum of $500 a week from workers' compensation. In total, a widowed spouse with no children will be paid no more than $150,000 total in weekly payments. Workers’ compensation benefits will continue until he or she remarries or openly cohabits with a person of the opposite sex. A dependent child of a deceased worker is eligible to receive weekly workers’ compensation payments until he or she reaches age 18.
Making a Claim
There are innumerable ways to be injured at work. Industrial accidents can cause devastating injuries. Workplace exposure to environmental toxins can lead to an occupational disease. Performing the same task over and over can cause a repetitive stress injury, such as carpal tunnel syndrome. A slip on a wet surface or a fall from a loading dock can result in painful sprains and broken bones.
No matter how your injury occurred, if it happened at work or while you were performing your job, it is covered by workers' compensation insurance. To receive workers' compensation benefits, however, you must properly file a workers' compensation claim.
- Report the Injury Immediately − It is important to report any on-the-job injury to your supervisor as soon as possible. If you fail to report the injury within 30 days, you may not be eligible to receive workers' compensation benefits. Reporting the injury does not constitute filing a workers’ compensation claim.
- Select a Doctor from the Approved List − Ask to see your employer's panel of workers’ compensation physicians − a list of doctors your employer has approved to treat injured employees. You must choose one of these physicians to treat your workplace injury.
- Obtain and Complete the Paperwork − Ask your employer for the paperwork required to make a workers' compensation claim. Complete it promptly and forward it to the appropriate organization for processing.
- Contact an Attorney – Although retaining an attorney is not required to file a workers’ compensation claim, it is best to have the advice of counsel when pursuing a workers’ compensation claim.
Disagreements over medical issues are common in workers' compensation claims. They can begin the first time you see the workers’ compensation doctor for a workplace injury. We can help you resolve all types of workers' compensation-related medical issues, including those involving failure to authorize treatment recommendations, including:
- Tests, such as MRIs
- Referrals to specialists
- Chiropractic care
After an on-the-job injury, you can follow all the proper procedures and still find your workers' compensation claim denied. What do you do then?
Generally, you have up to one year from the date of the injury to file an appeal with the Georgia State Board of Workers' Compensation. Our attorneys will analyze why your claim was denied and compile the facts and expert testimony required to show why your claim should be paid.
One of the most common workers' compensation problems involves injured workers who are sent back to work before they are physically able to do their jobs. In many instances, the workers’ compensation doctor will certify that the employee is able to go back to light duty work. This may involve working reduced hours or performing a job that is not physically taxing. After a day or two doing light duty work, the employer may send the injured worker back to his or her old job. Returning to work too soon or being assigned tasks that you are physically unable to perform can result in re-injury or a secondary injury. It can set your rehabilitation back weeks or months and, in some cases, cause permanent injury.
Many injured workers would prefer a lump sum settlement of their workers' compensation claim to continuing weekly payment of benefits.
We do not recommend that you settle your workers' compensation case until your doctor agrees that you have reached maximum physical recovery from your injuries and that no further improvement is anticipated. At that time, we can meet with the workers' compensation defense attorney and/or claims adjuster to work out a fair settlement arrangement.
Our attorneys will help you weigh the pros and cons of settling a claim. In cases involving catastrophic injuries that may require continuing medical attention, it may be to your advantage to keep your case open and continue weekly payment of benefits.
Trying the Case
If your problem with workers' compensation cannot be resolved in a hearing or an appeal within the workers' compensation system, do not give up. You do not have to take "no" for an answer.
Because we have extensive experience in workers' compensation litigation, we are able to analyze the results of a trial decision and determine whether or not we have grounds for an appeal to the Appellate Division of the Superior Court. If we believe the Superior Court's decision is in error, we can appeal your workers’ compensation case to the Court of Appeals and then to the Georgia Supreme Court, if necessary.
Third-Party Liability Claims
When a worker is injured on the job and that injury is caused by the negligence of a third-person (ie: Not a co-worker or his employer), then the injured worker may pursue a claim against the responsible person and/or company. A third-party liability claim offers the potential to recover damages not available under the workers’ compensation system. The damages in a third-party liability claim include damages for pain and suffering, lost wages, medical expenses and punitive damages. Third-party liability claims may be pursued simultaneously with workers’ compensation claims. Since these claims provide for a much greater level of recovery, they are often an important part of an injured worker’s effort to obtain full compensation for the financial burdens accompanying a severe injury.
Reasons for Retaining Counsel
It is extremely important for a worker who has been injured on the job and is unable to work for a period of time to consult with proper legal counsel. Although a worker does not necessarily need an attorney in every situation, the failure to hire counsel when an injury or loss of time at work warrants having counsel involved, will likely result in the injured worker losing substantial financial benefits. For instance, the following are common examples of benefits that injured workers failed receive:
- Employee may miss getting a PPD rating or at least an appropriate one;
- Employee will not have an opportunity to challenge the choice of physician as effectively;
- Employee will miss the chance to convert or effectively threaten to convert a case to a catastrophic case thereby losing substantial value in the claim at the time of settlement;
- Employee will be placed in a position of returning to work when they are not physically capable and may re-injure themselves;
- Employee will fail to secure a proper settlement at the end of their treatment and may find themselves out of work without a settlement; and,
- Employee may end up having to pay back medical and wage benefits from a third- party liability claim when such payment could be avoided.
For additional information regarding workers’ compensation and third-party liability claims and the process involved in pursuing these matters, please Contact our office by calling 877.343.9598 or online clicking here.
All initial consultations are without charge. Regardless of the nature of your workers’ compensation or third-party liability claim, it is important that you are aware of your rights and that you act quickly to protect those rights. Failure to act in a timely manner may result in the loss of your right to pursue appropriate legal action to recover for your personal injury.