FAQ – Workers’ Compensation in Georgia
What benefits are available if I am injured on the job?
In Atlanta and throughout Georgia, workers’ compensation provides medical care and disability benefits.
An injured worker is entitled to any and all medical care that will help him recover from his injury. Medical care is paid by the insurance company and there are no deductibles, no co-pays and no dollar limit for the care provided. Although there is no limit to the dollar amount of the care, there is a time limit for medical care. Medical care ends 400 weeks from the date of injury for non-catastrophic injuries occurring after July 1, 2013.
In addition to medical care, an injured worker is entitled to weekly disability income benefits to help compensate for lost earnings. There are three different types of income benefits: Temporary Total Disability, Temporary Partial Disability, and Permanent Partial Disability.
Temporary Total Disability is paid if you are unable to work. For injuries occurring after July 1, 2015 the maximum weekly benefit for total disability is $550.00.
Temporary Partial Disability is paid if you are able to work, but due to limitations caused by your injury you cannot earn what you were making prior to your injury. For injuries occurring after July 1, 2015, the maximum weekly benefit for Temporary Partial Disability is $367.00.
Permanent Partial Disability is a payment based on a ratings scale. You are paid Permanent Partial Disability for the effect that your injury has on the use of the injured part of your body. For example, if you suffer an amputation you are paid a lump sum for the loss of that part of your body. Although you are paid, you are not paid much. According to the OCGA 34-9-263, if you lose a leg, you get paid 225 weeks at your total disability rate so the most you are paid if you lose your entire leg is $123,750.00. If you only lose part of your leg, you are paid less. If you lose your foot, you are paid 135 weeks which would be a maximum of $74,250.00. As you can see the workers’ compensation system was designed by insurance companies, not the workers who depend on their arms and legs to make a living.
Effective representation by your attorney can make a major difference in what you are paid both during the claim and when the case is settled.
Why do I need a lawyer to help me get medical care?
Although the law gives you the right to medical care, the insurance company has to pay for the medical care. The insurance company wants to spend as little as possible on claims, including your claim. Below are some of the problems that you will encounter.
The insurance company will try to limit the parts of your body that are treated so that it will spend less on your claim. One of our clients was injured when an object fell striking her on the shoulder near her neck. The first doctor that saw her after the injury noted that she had pain in her shoulder, down her arm and in her neck. However by the time she was being seen by the company doctor, he was only treating her shoulder. During her treatment the company doctor asked for permission to do an MRI on her neck, but the insurance company refused any treatment for her neck. Although the doctor recommended an MRI for her neck, he was not willing to argue with the insurance company to get the treatment for his patient. We got her treatment and settled the case for a confidential amount which included treatment for her neck.
Insurance companies limit your choice of doctor to a list of approved doctors to treat you for your on-the-job injury. Not surprisingly the doctors on the list were picked by the insurance company. The insurance company searches for doctors that will treat you the way the insurance company wants you treated. An experienced workers’ compensation attorney can help you get treatment from a doctor who wants to treat you, not the insurance company. An experienced workers’ compensation lawyer can help you get treatment for all of your injuries, not just the less expensive ones.
Why is the doctor not taking me off of work and instead telling me to do light duty and why am I having to go to work when there is nothing I can really do?
The reason that your doctor is not taking you completely off of work is because he does not want the insurance company to send its business somewhere else. The reason the insurance company doesn’t want the doctor to take you off work is because the insurance company has to pay Temporary Total Disability benefits if the doctor takes you completely out of work.
When the doctor puts you on “light duty” restrictions the insurance company tells your employer that you should be working and asks your employer to provide a job that you can do. When your employer lets you work “light duty” it is the employer not the insurance company that is paying you. Although your employer may give you a “light duty” job, the employer usually wants you to do more work than you can actually do. You get caught in the middle. Your employer is having to pay you but there really is not work that you can do that makes you worth the same money that you were being paid before you were injured.
In its effort to save itself money the insurance company ruins your relationship with your employer. Your employer is paying wages but not getting the work it really needs. You have to go to work and possibly further injure self while trying to do some job that is much different from what you used to do.
An experienced workers’ compensation attorney can help you by either getting you off work or making sure that you aren’t hassled when you are working “light duty.”
Can I change doctors?
If you are not getting better, don’t trust your doctor or just don’t like your doctor, you could just go to a different doctor if this were not a workers’ compensation claim. With a workers’ compensation claim, you can only change doctors either by reaching an agreement with the insurance company or getting the Georgia State Board of Workers’ Compensation to order the insurance company to let you treat with a different doctor.
An experienced workers’ compensation lawyer can help you get to a doctor that is better for you and can provide better treatment. By knowing which doctors are best suited for your injury and by working for you within the system you can get better care.
What is a nurse case manager and why do they show up at my doctor’s appointments?
The nurse case manager who shows up at your doctor’s appointments can only be there if you do not object. Of course no one asked you if you did not want a stranger showing up at your doctor’s appointments. If you tell the doctor’s office that you do not want the nurse case manager coming into with you, then the doctor cannot let that person take away time that you should have with your doctor.
The nurse case manager is there to help the insurance company. The insurance company is paying this person to drive to the doctor’s office and spend time. The only reason for the insurance company to spend money on the nurse case manager is because it figures it will save enough money on medical care to more than cover the expense of having her show up. A second benefit for the insurance company is to keep the doctor aware of who is paying the bill and sending the patients.
How much money should I get each week if I am not able to work or return to work on restrictions?
When you are taken completely off work due to your injury, you are entitled to two-thirds (2/3) of your Average Weekly Wage (AWW). AWW is calculated based on your earnings for the 13 weeks prior to your injury. For example, if you are paid $750.00 per week by your employer, your weekly Temporary Total Disability (TTD) benefit is $500.00. If you were working two similar jobs and due to your injury on one of the jobs cannot work either job, you should be paid weekly disability benefits based on your earnings from both the jobs, but this is not something that the insurance company will offer to pay. An experienced workers’ compensation attorney will make sure you are paid based on all your lost earnings.
If you are not taken off work but rather placed on restricted duty, you are entitled to weekly benefits if you return to work, but earn less due to your injury. For instance, if you had worked overtime prior to your injury, but your employer has a policy of no overtime for light duty workers, then you are entitled to two-thirds (2/3) of your earnings loss. For example, if prior to your injury you were earning $180.00 weekly overtime, but when you returned to work light duty you were not permitted to work overtime while on light duty then you would be paid $120.00 per week Temporary Partial Disability (TPD) benefits: ($180.00 x 2/3). The insurance company will not explore your overtime earnings loss, but an experienced workers’ compensation lawyer can make sure you are paid benefits based on all the earnings that you have lost.
How long can I be paid weekly benefits?
The maximum period that you can be paid weekly benefits depends upon what type of benefits you are collecting. How long you can collect is measured from your date of injury. The maximum period for Temporary Total Disability (TTD) benefits is 400 weeks for a claim not designated catastrophic. For catastrophic claims the maximum is life. The maximum period for Temporary Partial Disability (TPD) benefits is 350 weeks.
An experienced workers’ compensation attorney can make sure that you will receive the correct amount of benefits and that you will receive your benefits for the correct length of time.
Dependency benefits are paid to the surviving dependents of a worker who dies from his injuries. Surviving dependents include spouse, dependent children and other dependents if proven to be dependent upon the deceased worker.
For a surviving spouse, the total compensation payable to a surviving spouse as a sole dependent at the time of death and where there is no other dependent for one year or less after the death of the employee shall in no case exceed $220,000.00
For a spouse and children, the dependency of a child, except a child physically or mentally incapable of earning a livelihood, shall terminate with the attainment of 18 years of age, but may continue to draw dependency benefits to age 22 if the child is enrolled as a full time student after age 18. The dependency of a spouse and of a partial dependent shall terminate at age 65 or after payment of 400 weeks of benefits, whichever provides greater benefits. IE: if a deceased employee is survived by both a spouse and children, the spouse can draw dependency benefits until age 65 if this is longer than 400 weeks.
The dependent children of a deceased worker are entitled to dependency benefits even if their parents are divorced. An experienced workers’ compensation attorney can make sure that each and every dependent child is paid the correct amount of benefits for the correct length of time.
If I become addicted to pain medication provided by my workers’ compensation doctor, is this still workers’ compensation?
Yes, a workers’ compensation claim provides any and all medical expenses that arise from your workers’ compensation injury. Georgia includes the following definition of injury:
Drug addiction or disabilities resulting therefrom shall not be deemed to be “injury” or “personal injury” by accident arising out of and in the course of employment except when such addiction or disability resulted from the use of drugs or medicines prescribed for the treatment of the initial injury by an authorized physician (OCGA 34-9-1 (4)).
Georgia law recognizes that the workers’ compensation insurance company gets to choose the doctors that see an injured worker. Sometimes the doctors chosen by the insurance company provide too much pain medication in the form of opioids or other addictive drugs. When an injured worker is given too much pain medication such as oxycodone or hydrocodone, he can become addicted to the drug. This addiction occurred because of the doctor’s treatment of the injury so that future treatment including detoxification must be paid by workers’ compensation insurer.
If the doctor has provided medication without proper safeguards, there may be a suit against the doctor for medical negligence.
Settlement – Should I settle and how much will I get?
Settlement of a workers’ compensation claim is when the injured worker receives a lump sum of cash to end the claim. Whether you should settle your claim requires consideration of a lot of different factors:
- Is my condition medically stable or do I have a continuing need for medical care
- Have I gotten well enough to return to work either doing my past work or some other work
- If I will not be able to return to work should I consider social security disability
- Should I file for social security before I settle my case or should I wait until after I settle my case to file for social security
- When is a good time to settle considering when my medical benefits and weekly benefits will run out
- Will my case be worth more if I settle now or wait
Settlement is a financial decision since you are trading your continuing right to medical care and weekly benefits for a lump sum. An experienced workers’ compensation attorney can help you identify all the factors to consider for your case and reach the best decision.
More Questions? We Have Answers.
If you have questions that we have not answered here, see the navigation bar for more in-depth answers to select questions. Our website provides general information, but every work injury is unique and brings different challenges. To determine the best course of action to get the workers’ comp benefits you need, it is best to speak with a knowledgeable injury lawyer with experience handling claims like yours.
At Hilley & Frieder, P.C., we offer a free initial consultation and we collect attorney fees only if we recover compensation for you. To speak with an attorney at no cost, please contact our Atlanta, Georgia, office at 404-233-6200.