Under Georgia law, employees who are injured on the job are eligible to collect benefits through workers’ compensation. The law provides that medical, rehabilitation, income, death and other benefits are awarded to employees and dependents due to injury, illness and death resulting from a compensable work-related claim. As a result, if you are injured on the job you are entitled to medical care and a paycheck while you are recovering. Workers’ compensation coverage begins the first day of employment and employers with three or more employees are required by law to provide this coverage.
If you are injured on the job, you should report your injury to your employer as soon as possible. Be as specific as possible when reporting your injury, and include anyone that witnessed your accident. Your employer is responsible for processing your workers’ compensation claims, and will generally investigate on-the-job accidents and injuries to determine if your claim is valid. Keep in mind that claims can be denied even though you sustained an injury. Injuries sustained from an employee’s willful misconduct, engaging in unassigned duties, during lunch and breaks, and during an employee’s normal commute to and from work are not covered. They are also several ways to jeopardize your claim and resulting benefits, including:
• Failure to report injuries promptly.
• Failure to cooperate with employer and authorized treating physician regarding medical evaluations, treatment, rehabilitation services and claim investigation.
• Refusal to return to suitable employment.
• Working elsewhere while receiving Temporary Total Disability Benefits.
• Submittal of fraudulent information.
• Refusal to take a drug test.
• Refusal to submit to a medical examination by the authorized treating physician, at reasonable times.
The rules and laws surrounding Workers’ Compensation are complex and getting these benefits can sometimes be a challenge. Employers and insurance companies are not always cooperative when it comes to handling claims, and claims can take an unpredictably long time to be resolved. Because Workers’ compensation is the “exclusive remedy” a worker has against their employer for an on-the-job injury, you want to ensure that are fully prepared as this is your only opportunity to be made whole from an injury on the job. At the Success Firm, we are equipped to guide you through the legal process, answer your questions and address your concerns in a swift and thorough manner. Whether you are first applying for workers’ compensation or your claim has been denied, we will work to ensure your wellbeing and advocate for your best interests.
Workers’ Compensation Questions and Answers
MEDICAL BENEFIT QUESTIONS
May I go to my personal physician for treatment for my on-the-job injury?
No. The law requires that you select from a list of physicians posted by your company in a prominent location. In addition, the law requires that you are informed of this list and understand its function. One of the following referral methods may be used.
Panel of Physicians – This must contain at least six qualified physicians. The makeup of the panel must include one orthopedic surgeon, a minority physician and four other properly qualified physicians.
Conformed Panel – This must include at least ten qualified physicians.
Workers’ Compensation Managed Care Organization (WC/MCO) – A WC/MCO offers a much larger choice of treating physicians from many disciplines. The WC/MCO must be approved by the State Board of Workers’ Compensation.
If you are dissatisfied with your first selection, you may make one change to another physician from the posted list. Any further change of physician will require concurrence of your company and/or the workers’ compensation administrator.
Should you choose to go to a doctor not on the approved list, this is considered unauthorized treatment, and your employer will not be responsible for the cost associated with this medical care. In addition, most health insurance policies will not pay for medical treatment associated with an on-the-job injury.
How will I identify the List of Physicians?
The list of physicians will be printed on 8.5´x 14” paper titled “OFFICIAL NOTICE. This business operates under the Georgia Workers’ Compensation Law.” It will contain the name, specialty, address and phone number of the authorized physicians.
What must I do if I need emergency treatment?
In a true emergency situation, you may get temporary medical care from the nearest emergency location available. Once the emergency is over, however, you must continue your care by selecting a doctor from the list of physicians provided by your employer.
What happens if I need surgery?
Prior to scheduling any major surgical procedures for an on-the-job injury, except in the case of an emergency, your doctor will notify your employer or workers’ compensation provider. Once your employer has been contacted, the appropriate workers’ compensation professional will work with your physician and/or his/her medical staff to ensure that all the necessary arrangements are made.
What if the doctor says that I need a MRI or CT scan?
Your authorized treating physician will arrange for these tests. Feel free to ask your physician what the test is for and why you need it.
What if I need physical therapy?
Your authorized treating physician will refer you to a physical therapy provider.
Am I required to pay a portion of the cost of the medical care I receive resulting from my on- the-job injury?
No. Your physician’s bills and reasonable medical bills are covered if a physician authorized by your employer treats you. All medical charges are paid according to the Georgia Workers’ Compensation Medical Fee Schedule. If your medical provider charges above the fee schedule, the charges will be reduced to the fee schedule, and that amount will be paid. YOU ARE NOT RESPONSIBLE FOR CHARGES ABOVE THE FEE SCHEDULE; however, if you are billed for those costs, contact your employer or workers’ compensation provider to assist in getting the charges corrected.
If the physician prescribes medicines for me, what do I do?
Prescription drugs are covered under workers’ compensation. Check with your employer or workers’ compensation administrator to see if they have any special procedures in place for obtaining prescription drugs. If no special arrangements have been made, you may have to pay for the prescription and submit the bill to your employer for reimbursement.
Are there any expenses that I incur that will be reimbursed to me?
The Workers’ Compensation Statute provides for reimbursement of certain reasonable personal expenses incurred to obtain medical treatment. This includes such things as mileage, meals, lodging and other expenses, in limited instances, which are deemed necessary and appropriate in order to ensure you receive quality medical care. You should check with your workers’ compensation professionals before incurring expenses.
How long do reimbursements take?
Approved expenses will be reimbursed within 15 days of submission as required by the Workers’ Compensation Statute. However, most carriers process reimbursements in less time. If reimbursements are not paid within fifteen (15) days of receipt of documentation requesting reimbursement, penalties shall be added in addition to the reimbursement amount. It is important to submit your approved expenses within a year’s time of the date of service otherwise you will have waived your right to collect such charges from the employer or workers’ compensation insurer.
What will happen if I am unable to work because of my on-the-job injury?
You are entitled to receive weekly Temporary Total Disability benefits if you miss more than seven days from work. Only if you are out more than 21 consecutive days due to your injury will you be paid for the first seven days. Your first check should be mailed to you within 21 days after the first day of disability. You will receive two-thirds of your average weekly wage, but not more than the maximum rate provided by the Workers’ Compensation act at the time of your injury. Your authorized treating physician must verify your disability and absence from work.
What if I cannot perform my regular job and another job is not available?
You would be eligible to receive Temporary Total Disability benefits if you are unable to work due to your on-the-job injury. You should also consult your employer regarding possible vocational rehabilitation opportunities.
What happens if my disability becomes permanent?
If your authorized treating physician determines you have suffered a permanent disability, you would be entitled to receive Temporary Total Disability benefits for as long as you remain disabled. If you are able to work, you would begin receiving a weekly income benefit based on the permanent disability rating given you by your authorized treating physician. (See next question – PERMANENT PARTIAL DISABILITY). The benefit would be paid to you regardless of your wage rate or total income.
What income benefits are available under the Workers’ Compensation Program?
The Workers’ Compensation Statue provides four basic income benefits. The maximum amount of weekly workers’ compensation benefits an employee can receive from an on-the-job injury, illness or death depends on the workers’ compensation rate at the time of the injury and the employee’s average weekly wage.
Temporary Total Disability Benefits – This benefit is payable to an employee who is injured on the job and unable to work as determined by the authorized treating physician. The amount is two-thirds of the employee’s average weekly wage at the time of the injury, not to exceed the maximum amount allowed under the law. For non-catastrophic injuries, there is a limit of 400 weeks of benefits from date of injury if the injury occurred on or after July 1, 1992. For catastrophic injuries, benefits are unlimited.
Temporary Partial Disability Benefits – This benefit is payable to an employee when he/she returns to work in a job paying less as a result of an on-the-job accident. These benefits are payable for up to 350 weeks from the date of injury. This lost wage amount is two-thirds of the difference between the employee’s average weekly wage before and after the injury. The maximum amount payable cannot exceed the maximum allowed under the law.
Permanent Partial Disability Benefits – This benefit is payable to the employee for a permanent disability resulting from an on-the-job injury. It is payable based upon a percentage given by your authorized treating physician in accordance with current AMA Guidelines. The percentage is calculated by a formula that contains number of weeks assigned by O.C.G.A 34-9-263(c) multiplied by the percentage rating multiplied by the Temporary Total Disability rate. Not all injuries result in ratings assigned by a physician.
Death Benefits – This benefit is payable to eligible dependents (i.e., dependent spouse, minor children) of an employee whose on-the-job injuries result in death. This benefit is payable at the rate of two-thirds of the deceased employee’s average weekly wage at the time of the accident not to exceed the maximum allowed under the law for all eligible dependents. Funeral Expenses are payable up to the maximum allowed under the law at the time of injury.
Benefits cannot be combined. Only one type of benefit is payable at a time.
What happens to my workers’ compensation benefits if I receive a light-duty release from my physician while I am out of work?
Your employer will try to place you in a job that meets the limitations placed on you by your physician. However if a light-duty job is not available and you remain out of work in a light-duty status for 52 consecutive weeks or, if periods of disability are interrupted, a maximum of 78 total calendar weeks, your income benefits will be reduced automatically by law from the Temporary Total Disability benefit to the maximum eligible Temporary Partial Disability benefit.
If you are given a light-duty release and a light-duty job is available, your employer will expect you to return to work. The Workers’ Compensation Statue provides for a 15-working-day “grace period.” This allows an employee to attempt to perform a light-duty job without fear of losing benefits if they are unable to perform the job duties. An attempt is defined by eight cumulative hours or one scheduled workday, whichever is greater.
If you have been injured in a car accident, the stress from the pain combined with medical bills and lost wages can cause you to struggle both physically and financially. Even if there is sufficient insurance coverage to address your claim, some insurance companies are not always willing to settle and ensure that injured parties are made whole. Therefore, you may not be able to obtain full recovery for your damages unless you pursue a claim against the at-fault party.
Having a lawyer by your side doesn’t mean you are filing a lawsuit. This only means that you are protecting your rights, if the insurance company refuses to pay for all of your damages. Never sign anything before talking to a lawyer, to guarantee that you get the fair compensation you deserve, not a quick settlement. Our firm can help you recover for medical bills, lost wages and any other pain and suffering.