For more information, please see Frequently Asked Questions – Workers’ Compensation

 

WORKERS’ COMPENSATON

 

OVERVIEW

Established in 1920 by the Georgia legislature, the State Board of Workers' Compensation serves over a quarter of a million employers in Georgia and over 3.8 million workers.  The State Board is funded by assessments from insurance companies and self-insured employers.  An employee that is injured on the job and is covered by the law may be eligible for replacement of a portion of lost wages, medical payments, vocational rehabilitation services and other benefits.

 

Prior to the passage of the Workers' Compensation Act, an employee who was injured on the job could not expect benefits from the employer. Men, women, and children were often subjected to harsh and oppressive working conditions with little or no recourse for work-related injuries. Courts often denied recovery to employees by holding that employees assumed risks in taking the job, were negligent, or were barred from recovery by the negligence of a fellow employee. Filing a suit in court was also unsatisfactory because trials were expensive and often lengthy. This posed a problem to an employee who needed money immediately to pay for medical expenses and replace lost wages. A successful suit could also force a small company out of business.

 

Today, the workers' compensation law provides for specific benefits to be paid to employees for injuries arising out of and in the course of employment, without regard to negligence or fault, and at the same time, provides the employer with limited liability. In Georgia, employers obtain worker's compensation coverage through private insurers or programs of self-insurance. The rights granted an employee under the law preclude any other legal remedies against an employer by an employee due to a work-related injury.

 

The law is applicable to all employers, including public corporations and nonprofit organizations that have at least three full-time or part-time employees.

 

There are several categories of workers who are specifically exempted from the workers' compensation law: federal government employees, railroad employees, farmers and farm laborers, and domestic servants, to name a few.

 

If facts concerning a claim are contested or liability is questioned, either the employee or the employer/insurer may request a hearing before an Administrative Law Judge to resolve the issues. If either party is dissatisfied with the decision, a party may request a review by the Appellate Division. Further appeals may be taken through the court system; however, the courts can review only disputed questions of law, while Administrative Law Judges and the Appellate Division determine both factual and legal issues.

 

Although the Subsequent Injury Trust Fund is a separate state agency, the Board and the Fund work closely together. The Fund reimburses the employer/insurer for a portion of workers' compensation benefits paid in cases where a preexisting permanent impairment combines with a subsequent injury to produce a greater disability than would have resulted from the subsequent injury alone. The workers' compensation program is entirely funded by assessments from insurance companies and self-insured employers.

 

 

EMPLOYEE’S RIGHTS

1.                  If you are injured on the job, you may receive medical rehabilitation and income benefits. These benefits are provided to help you return to work.  Your dependents may also receive benefits if you die as a result of a job-related injury.

2.                  Your employer is required to post a list of at least six doctors or the names of the certified WC/MCO that provides medical care, unless the Board has granted an exception. You may choose a doctor from the list and make one change to another doctor on the list without the permission of your employer. However, in an emergency, you may get temporary medical care from any doctor until the emergency is over, then you must get treatment from a doctor on the posted list.

3.                  Your authorized doctor bills, hospital bills, rehabilitation in some cases, physical therapy, prescriptions, and necessary travel expenses, (including mileage reimbursement to medical providers) will be paid if injury was caused by an accident on the job.

4.                  You are entitled to weekly income benefits if you have more than seven days of lost time due to an injury. Your first check should be mailed to you within 21 days after the first day of missed work. If you are out more than 21 consecutive days due to your injury, you will be paid for the first week.

5.                  Accidents are classified as being either catastrophic or non-catastrophic. Catastrophic injuries are those involving amputations, severe paralysis, severe head injuries, severe burns, blindness, or of a nature and severity that prevents the employee from being able to perform his or her work and any work available in substantial numbers within the national economy (for which you are qualified). In catastrophic cases, you are entitled to receive two-thirds of your average weekly wage but not more than $500 (2008) per week for a job-related injury for as long as you are unable to return to work. You are also entitled to receive medical and vocational rehabilitation benefits to help in recovering from your injury. If you need help in this area call the State Board of Workers’ Compensation at (404) 656-3818 or our office at (478) 923-0300 for help and more information concerning catastrophic claims.

6.                  In all other cases (non-catastrophic), you are entitled to receive two-thirds of your average weekly wage but not more than $500 (2008) per week for a job-related injury. You will receive these weekly benefits as long as you are totally disabled, but no longer than 400 weeks. If you are not working and it is determined that you have been capable of performing work with restrictions for 52 consecutive weeks or 78 aggregate weeks, your weekly benefits will be reduced to two-thirds of your average weekly wage but no more than $334 per week, not to exceed 350 weeks.

7.                  When you are able to return to work, but can only get a lower paying job as a result of your injury, you are entitled to a weekly benefit of not more than $334 per week for no longer than 350 weeks.

8.                  Your dependent(s), in the event you die as a result of an on-the-job accident, will receive burial expenses up to $7,500 and two-thirds your average weekly wage, but not more than $500 (2008) per week. A widowed spouse with no children will be paid a maximum of $150,000. Benefits continue until he/she remarries or openly cohabits with a person of the opposite sex. (This is assuming that every injured employee is heterosexual.)

9.                  If you do not receive benefits when due, the insurance carrier/employer must pay a penalty, which will be added to your payments.

 

 

Information provided by Georgia State Board of Workers’ Compensation.

 

MEDICAL BENEFITS

While on a national basis, Georgia’s injured workers receive a small amount in income benefits, as compared with other states; Georgia’s medical benefits are ranked some of the best. These medical benefits are not provided through co-insurance and you’re not required to pay any deductibles. 

 

If your claim is filed timely (within one year from the date of accident) your medical benefits in reference to these work-related injuries can extend the rest of your lifetime.  Medical benefits for your work-related injuries will continue regardless of whether you’re working for the same employer, whether you’ve changed jobs and now work for a different employer, or whether you’re working at all.  Although, subsequent injuries while working for a new employer may become the responsibility of the new employer, constituting an aggravation of a pre-existing condition, if the new employer were aware of the pre-existing condition prior to hiring you.

 

Although Georgia’s workers’ compensation medical benefits are excellent in theory and on paper, it’s sometimes difficult to get the treatment you need from medical providers because, although not required by the State Board of Workers’ Compensation, they will insist that they receive preauthorization for the treatment from the employer/insurer prior to issuing the treatment.  This unfortunate reality can sometimes delay treatment and result in further medical problems. 

 

Some important elements of medical benefits include:

1.                  Causation – The need for the medical treatment must be directly related to the on-the-job compensable injury.  The employer/insurer may even be responsible for diagnostic tests performed to determine whether or not a condition was caused by the injury.  The employer/insurer may even be responsible for these charges when the tests results determine that the condition is not related to the on-the-job compensable injury.

2.                  Authorized Care – An authorized provider must render the care you receive. Generally, you receive treatment from your authorized treating physician, who in turn can refer you to other providers for treatment, but these providers are not allowed to refer you further to additional providers or for additional diagnostic testing.  All treatment referrals and diagnostic testing referrals must go through your authorized treating physician, unless the treatment you receive is emergency treatment, as provided in the statute.

3.                  Effect a Cure, Give Relief, or Restore the Employee to Suitable Employment – This element is one of the main things that an administrative law judge will consider when medical issues arise.  O.C.G.A. 34-9-200(a) states that the medical treatment the injured employee receives “shall be reasonably required and appear likely to effect a cure, give relief, or restore the employee to suitable employment.”    The section was designed to bring about, hopefully for the better, a change in the employee’s medical condition.  If a medical issue is put before the Board, it is the injured employee’s burden to prove that the medical treatment provided or for which they are seeking has or will effect a cure, give relief, or restore him/her to suitable employment.

4.                  Medical Charges Must be Usual, Customary and Reasonable – The State Board reserves the right to approve all charges, both as to the amount and necessity.  Administrative law judges make decisions on a regular basis concerning whether or not an injured employee’s medical treatment is necessary or not.  They can even rule that the treatment is not necessary when the injured employee has some evidence showing that the treatment is necessary.  This is where the preponderance of evidence takes over and your claim get more complicated.  Should you confront issues such as this, please consult with a reputable workers’ compensation attorney concerning your rights. 

 

An injured worker who files his/her claim within one year of the date of injury is entitled to lifetime treatment for the work injury.  If income benefits have been paid in the claim, there is no reason to file a claim, the claim was started when the injured employee started receiving income benefits and he/she has a lifetime right to medical treatment. Even if an injured employee started receiving income benefits and then retained an attorney to help with his/her claim, the attorney would probably go ahead and file a Notice of Claim in reference to the injury to assure that the injured employee’s rights to medical treatment are preserved.

 

 

 

EMPLOYEE’S RESPONSIBILITIES

1.                  You should follow written rules of safety and other reasonable policies and procedures of the employer.

2.                  You must report any accident immediately, but not later than 30 days after the accident, to your employer, your employer’s representative, your foreman or immediate supervisor. Failure to do so may result in the loss of the benefits.

3.                  Any employee has a continuing obligation to cooperate with medical providers in the course of their treatment for work related injuries. You must accept reasonable medical treatment and rehabilitation services when ordered by the State Board of Workers’ Compensation or the Board may suspend your benefits.

4.                  No compensation shall be allowed for an injury or death due to the employee’s willful misconduct.

5.                  You must notify the insurance carrier/employer of your address when you move to a new location. You should notify the insurance carrier/employer when you are able to return to full-time or part-time work and report the amount of your weekly earnings because you may be entitled to some income benefits even though you have returned to work.

6.                  A dependent spouse of a deceased employee shall notify the insurance carrier/employer upon change of address or remarriage.

7.                  You must attempt a job approved by the authorized treating physician even if the pay is lower than the job you had when you were injured. If you do not attempt the job, your benefits may be suspended.

8.                  If you believe you are due benefits and your insurance carrier/employer denies these benefits, you must file a claim within one year after the date of last authorized medical treatment or within two years of your last payment of weekly benefits or you will lose your right to these benefits.

9.                  If your dependent(s) do not receive allowable benefit payments, the dependent(s) must file a claim with the State Board of Workers’ Compensation within one year after your death or lose the right to these benefits.

10.              Any request for reimbursement to you for mileage or other expenses related to medical care must be submitted to the insurance carrier/employer within one year of the date the expense was incurred.

11.              If an employee unjustifiably refuses to submit to a drug test following an on-the-job injury, there shall be a presumption that the accident and injury were caused by alcohol or drugs. If the presumption is not overcome by other evidence, any claim for workers’ compensation benefits would be denied.

12.              You shall be guilty of a misdemeanor and upon conviction shall be punished by a fine of not more than $10,000 or imprisonment, up to 12 months, or both, for making false or misleading statements when claiming benefits. Also, any false statements or false evidence given under oath during the course of any administrative or appellate division hearing is perjury.

 

 

Information provided by Georgia State Board of Workers’ Compensation.

 

 

 

For more information, please see Frequently Asked Questions – Workers’ Compensation

 

 

 

 

Contact: Kathleen S. Grantham, Esq.

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The information obtained from this site is not, nor is it intended to be, legal advice. Always consult with an attorney for advice pertaining to your individualized case.

 

Grantham Law Office

403½ S. Pleasant Hill Rd.

Warner Robins, Georgia 31088

(478) 923-0300