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Worker’s Compensation Frequently Asked Questions

Q.  What is Workers’ Compensation?
A.  Workers’ compensation is a benefits program created by state law that provides medical, rehabilitation, income, death and other benefits to employees and dependents due to injury, illness and death resulting from a compensable work-related claim covered by the law.

Q.  When am I covered?
A.  Workers’ compensation coverage begins the first day of employment.  Employers with three or more employees are required by law to provide coverage.

Q.  What is considered an on-the-job injury, illness, and death claim?

A.  Any injury, illness, or death arising out of and in the course of employment is by definition a compensable work-related claim.  This means if employees are injured while performing assigned job duties during assigned work hours, they are covered under the workers’ compensation program.  Injuries sustained while engaging in unassigned duties, during lunch and breaks, are not covered.  In addition, injuries that occur during an employee’s normal commute to and from work are not covered.

Q.  Can I receive from my employer money damages in addition to workers’ compensation benefits if I am injured on-the-job?

A.  No.  Workers’ compensation is the “exclusive remedy” a worker has against his/her employer for damages resulting from an on-the-job injury.

Q.  Are there any expenses that I incur that will be reimbursed to me?

A.  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 that are deemed necessary and appropriate in order to ensure you receive quality medical care.  Be sure to use the enclosed Mileage and Parking Reimbursement form to record your expenses.  You must also keep your receipts for all expenses incurred, such as parking.

Q.  What income benefits are available under the Workers’ Compensation Program?

A.  The Workers’ Compensation Statute 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 injury and the employee’s average weekly wage.  Benefits cannot be combined.   Only one type of benefit is payable at a time.

Temporary Total Disability (TTD) 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 injury, not to exceed the maximum allowed under law.  For non-catastrophic injuries, there is a limit of 400 weeks of benefits from the date of injury if the injury occurred on or after July 1, 1992.  For catastrophic injuries, benefits are unlimited.

Temporary Partial Disability (TPD) 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 amount allowed under the law.

Permanent Partial Disability (PPD) 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 the State Board x the percentage rating x the TTD 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 under the law at the time of injury.

What If…

…I receive a Hearing Notice? Or other documents from the State Board of Workers’ Compensation?
    
Any and all documentation you receive from the State Board of Worker’ Compensation, such as Hearing Notices, are also received by your attorney.  You do not need to call your attorney since he has already received the same notices.  He will call you before a scheduled hearing and make sure that you are prepared.

…my court hearing gets rescheduled or continued?

There are many instances that a hearing will be re-scheduled.  It is not bad if your hearing is rescheduled.  It usually means additional evidence, such as medical record or depositions, need to be collected.  Or it could simply be a scheduling conflict between the parties involved.
    If your hearing is rescheduled, you will be given plenty of notice before the next hearing is scheduled.

…my doctor tells me to go back to work?

There are several procedures that must be followed by your employer and their insurance company before you must return to work, not just a release from the doctor.  Always call your attorney before you return to work to make sure that the proper procedures are being followed.

…a “Medical Case Manager” or a nurse who works for the insurance company calls me?

Tell them politely that you have an attorney and that they should call your attorney.  You are not required to talk to this person.

…my employer calls me?

Tell them politely that you have an attorney and that they should call your attorney if they have.

…the insurance company wants to take a recorded statement?

    Do not agree to that under any circumstances.  Politely tell the insurance adjuster to call your attorney.

…my weekly benefit check is late?

Do NOT call your attorney unless your check is over one week late.  Usually the postal service or a holiday is to blame for the delay.  Most late checks arrive within a couple of days.

…I cannot get in touch with my attorney?

Your attorney is extremely busy with court hearings and depositions every day of the week.  If you call the office and your attorney is not available, please speak with one of his assistants.  They will be able to answer the majority of your questions, and if they cannot, they will make sure that your attorney gets the message and returns your call as soon as possible.

There are five types of benefits available to workers injured on the job.  The types of benefits you are entitled to depend upon how your medical reports are applied to the law.  Settlement is based on the value of future benefits.  Note:  Benefits may vary depending on the date you were injured.  This outline is meant to be general, and is not to be relied upon without an attorney’s advice.

Temporary Total Disability Benefits
a.    The doctor must certify in writing that you are unable to work.
b.    This qualifies you for 2/3 (67%) of your wage loss.  (The most you can get is $500/week)
c.    You are only allowed to collect Temporary Total Disability benefits for up to 400 weeks from the date of your injury, unless you are deemed “catastrophically” injured.  Benefits may also be reduced if you are released to light duty.

Temporary Partial Disability
d.    The doctor must certify that you have a partial wage loss due to your work-related injury.  You may draw this benefit for 350 weeks from the date of injury, unless your case is deemed catastrophic (unable to work any reasonable job).
e.    You may get 2/3 of your wage loss.  (The most you can get is $334.00/week.)
For Example:  If you made $300.00/week before your injury, and because of your injury you now make $200.00/week, your benefits would be $300.00-$200.00=$100.00; $100.00 x 2/3 = $66.67/week

Permanent Partial Disability
f.    The doctor must certify that the work-related injury caused “Permanent Disability” using the American Medical Association’s “Guides to Evaluation of Permanent Impairment.”  Each body part is worth a certain amount of money.
For Example:  Your whole hand is worth 160 weeks of wage loss benefits.  If it is 10% permanently disabled, you are entitled to 16 weeks benefits.  If you qualify for $500.00/week, this would be 16 x $500.00= $8,000.00.

Medical Treatment
g.    You must be allowed to choose a doctor from the employer’s list of six doctors.  If you are unhappy with the first doctor you see on this posted panel, you have a free choice to select any other doctor on the posted panel, without interference from your Employer.  If the Employer does not follow proper procedure, then you may pick you own “authorized” doctor.
h.    The doctor who is “authorized” must be paid in full by the employer or the employer’s insurance company.  They have a limited time to say if they will approve treatment or surgery.
i.    If the Employer’s Panel is in violation of Georgia Law, you may pick any doctor you want.  One of the doctors on the panel should be an orthopedist.  No more than two may be “industrial clinics,” and at least one has to be a minority.  The panel must be explained to you after you are hurt.
j.    Medical treatment is paid directly to the doctor.  You should be reimbursed for you traveling expenses at $.40 per mile as well as for prescriptions and any of their medical services prescribed by your authorized doctor (such as attendant care).

Rehabilitation Services
k.    In order to qualify for Rehabilitation Services, your on-the-job injury must be considered “catastrophic,” or by agreement with the insurance company.  This benefit is usually optional and may be turned down.
l.    Light Duty Return to Work:  If the treating physician gives you a release to return to work with restrictions and limitations, then, before returning to work, you must be presented with a signed and approved light-duty job description within those restrictions and limitations by the authorized treating physician.  If not, then you are not required to return to work.

*Time limits:  Normally, a claim must be filed with the State Board of Workers’ Compensation (404) 656-3875 within one (1) year of date of injury.  Exceptions include that you may file within two (2) years of being paid workers compensation income benefits.  There are several other exemptions to the length of time to file a claim.

THERE IS NO RECOVERY UNDER GEORGIA WORKERS’ COMPENSATION LAW FOR
PAIN AND SUFFERING.

Other Benefits

You may be entitled to other claims besides Workers’ Compensation.  Strict time limits apply.

Unemployment Benefits (404) 656-3017 – If you are terminated without proper cause while you are still able to do the essential part of your job you may be entitled to benefits.

Social Security (800) 772-1212 – If you think you will be disabled for more than twelve (12) months, file for Social Security benefits after being off work for five (5) months.

Discrimination (800) 669-4000 – If you are terminated for a handicap, race, gender, age, etc., you should file a discrimination claim within six (6) months of the occurrence.

Third Party Claim – If someone besides your employer “negligently” caused the injury, you may have an additional claim against them. (e.g., car wreck, defective machine, etc.)

OSHA (Safety Violation) (800) 321-6742

GOING TO THE DOCTOR

When a doctor has been authorized to treat you concerning your work injury, he or she is your doctor.

Board Rule 200(c)(2) states, “Nothing contained herein shall be construed to abridge the employees continued right to schedule his/her appointment for authorized medical treatment.”  This means that you should be able to schedule your own appointments with your doctors and not have to rely upon the insurance company to schedule them for you.

You should not forget that an insurance company adjuster may attempt to interfere with your doctor/patient relationship by making calls to your doctor to suggest a different treatment plan or referral for other doctors who have “special” ongoing relationships with these same insurance companies.

It is important that you talk with your doctor and get answers to your questions about your treatments.

o    If the doctor suggests physical therapy, an FCE (functional capacities evaluation), or treatment by another doctor or specialist (for example a neurologist, orthopedic surgeon, etc.), ask the doctor to give you this referral with only the specialty needed, do not have him name a specific group or doctor.

o    If the doctor has put a name of a specific group and/or doctor on the referral, ask the doctor why he has chosen this particular group and/or doctor and if the name came from the adjuster or insurance company.

If something changes concerning a treatment plan the doctor had earlier discussed with you, ask him why and if this change in treatment was suggested by the adjuster or insurance company.

It is always a good idea to write down your questions for your doctor before getting to see him.  This will help you get the answers to all of your questions while you are in with the doctor.

It is always a good idea to take notes of what the doctor tells you as soon as you can.  Be as accurate as possible on what was said in the conversation.

If you find your doctor or their staff members having ongoing talks with representatives of the insurance company, please let our office know as soon as possible.