Georgia’s workers compensation system has undergone significant changes in the last year, while improving to an all-time high weekly maximum benefit payout. Those changes, though, are considered more long overdue than peachy-keen progress.
Thanks to the pen of Gov. Brian Kemp on July 1, 2019, Georgia’s maximum workers comp payout was lifted to $675 per week, which amounted to a $100 increase (or a hike of 14.8%).
Which means Georgia now has the fifth-worst payout figure in America instead of the second-worst.
“On the plaintiff’s side, we think it would be much better if it was an index (based on the state’s per capita income) instead of a flat figure,’’ said Atlanta-based lawyer Thomas Holder, who has been handling workers comp cases in Georgia for nearly 40 years. “The maximum went up, but it’s always a negotiation with the insurance companies and we feel vulnerable to losing ground in other areas.
“In all my years doing workers comp, it has never gone up that much. The bottom line is you were never going to be able to support a family on that amount and you still can’t do that. But that’s the system in Georgia.’’
Georgia’s system has other distinctions, most of which don’t seem especially friendly to the injured worker.
Need a doctor to validate your on-the-job injury? It must be one that’s offered by the company. You do get a choice, but from a list of six doctors that’s displayed at the workplace (exception: If there’s an emergency, you can temporarily use someone else).
“If you get hurt, you have to go to one of their doctors,’’ Holder said. “Other states are more of an employee choice. But for all practical purposes, the employer controls the medical in Georgia.’’
Georgia is one of four states to have limits on major medical, capping coverage at 400 weeks in cases (unless the case is deemed catastrophic) where other states offer lifetime benefits.
With Georgia being a right-to-work state, employers can fire employees at any time, perhaps providing a chilling effect for workers who are considering whether to file a claim. “Especially in these times of COVID-19, when you’re concerned about finding a job if you lose one, some people are going to feel pressure not to complain,’’ Holder said.
There’s also a quirk in Georgia law that allows insurance companies to provide injured workers medical treatment without paying indemnity benefits or accommodating lighter accommodations at work. It’s considered a denial of a claim, even though there’s medical treatment.
“There are often things stacked against the worker,’’ Holder said. “I tell them it’s important to document everything. Write your own record. You don’t want to leave any stone unturned.
“Workers comp can be tricky. If you get hurt on the job and are looking for some direction, it can be difficult. Think about it. If you’re injured, not working, or your income has been reduced, you’re probably in big trouble. Our clients come to us with all three.’’
Holder said Georgia’s workers comp lawyers are dedicated to fighting for access to medical care and would love for clients to have more of a voice in determining who treats their injuries. He urged all injured workers to contact a lawyer, just to get information and education at minimum.
“You need people on your side,’’ Holder said.
Here are some ways to successfully comply with Georgia’s workers compensation system.
How to File A Workers Compensation Claim in Georgia
It’s relatively simple to file in Georgia, but it’s important to know the workers compensation system process, getting the initial form processed and not letting any details slip through the cracks.
The injured employee, the employer and the insurance carrier all have roles to play in the process. But it starts with the employee, who ideally will inform their supervisor immediately after the injury occurs before going to one of the six employer-provided doctors for medical treatment. Georgia law states that the employee has 30 days from the date of the accident to report the injury. There’s also a one-year statute of limitations on the claim to be effective, provided you met the 30-day stipulation of informing your employer.
Even if you don’t feel the injury is major, timing is of the essence. On some occasions, you might suffer what seems like a minor cut or muscle pull, and not feel it’s worth the effort for immediate treatment. But in time, that cut could get infected or the muscle pull might become more severe. Perhaps several weeks after the fact, you might really need treatment.
So it’s vital to report your injury to a supervisor right away. Get it on record that you could need medical attention. That simple act could save you lots of frustration and aggravation.
Employer’s Responsibility for Filing Claim
The Georgia employer and/or company responsible for handling workers compensation claims will investigate on-the-job accidents and injuries. The investigations are deemed necessary to determine how and why the injury occurred, then to possibly implement policies and procedures that will make for a safer workplace.
Workers compensation will not provide benefits for an injury or accident resulting from an employee’s willful misconduct (defined as fighting, horseplay, willful act of third party for personal reasons or injuries related to alcohol or drug abuse). If the injury occurs due to haste or inattentiveness, it will generally be covered. But the employee might be subject to company discipline if they weren’t following company policies or safety rules.
Immediately upon knowledge of a workplace injury, the employer must file a report with its insurance carrier or self-insurer’s claims office. If the injured worker misses more than seven days due to the injury, the employer must inform the State Board of Workers Compensation within 21 days of that disability.
Georgia employers are required to have workers compensation insurance coverage. Employees can report a suspicion of fraud or non-compliance to the Board’s Enforcement Division at (404) 657-7285.
Insurance Carrier’s Responsibility
The insurance carrier, which will conduct its own investigation, will file a First Report of Injury with the State Board of Workers Compensation. Copies will be mailed to the employee and employer. The insurance carrier is also obligated to mail a brochure to the injured employee that explains the rights, benefits and procedures for obtaining benefits.
The insurance carrier will require all written statements and accident reports, along with the names of all witnesses and the employee’s payroll records for 13 weeks prior to the injury.
Deadlines for Georgia Workers Comp Claims
Here’s a review on the deadlines you must hit to avoid any snags:
Deadlines for Notifying Employers — Immediately is best. But Georgia law allows you 30 days to report the injury after you’ve been hurt on the job. In some cases, just telling your supervisor or having a supervisor witness the accident without verbal confirmation could be enough. The timing might seem hard to define because some work-related injuries aren’t due to a specific accident, but occur from overuse or repetitive activities. But to be safe, it’s best to tell a supervisor immediately after you’re injured. It’s also best to do it in writing.
Deadlines for Filing Claim — In Georgia, if the employer has taken no action to provide the injured worker with either medical treatment or benefits, the worker has up to one year to file notice with the SBWC about their claim. It requires a specific WC-14 form. That same form can be filed within one year from the last medical treatment paid for by the workers compensation insurance carrier (and not your health insurance). The WC-14 is accepted within two years of the injury if you have received some lost wages, but are still seeking money because you can’t work, have work restrictions or are earning less due to the injury.
Deadlines for Occupational Diseases — You generally have one year after the date that you knew (or should have reasonably known) of the disease and how it was caused by your employment. With few exceptions (notably asbestosis or mesothelioma), you can’t file a claim more than seven years after your last exposure to the work hazard.
How to Appeal a Claim Denial
What if your workers compensation claim is denied in Georgia? You have rights and specific avenues to follow.
First, it’s understandable if you’re confused and angry over this roadblock. What happened? Your claim could be denied as a whole (meaning the insurance company doesn’t believe there was an injury) or through a certain aspect (maybe medical treatment with a specific doctor or denial of a specific body part that that the claim says was hurt on the job). The insurance company could assert that your injuries are not catastrophic or it may not believe they were due to a workplace accident.
So how do you appeal? The process can be difficult, so it’s advisable to hire an attorney, who can guide you through any reviews with the Georgia SBWC.
Here are the steps to challenging your denial:
File A Claim — In a 2019 survey of Georgia plaintiffs who received benefits after initially being denied, more than half said they filed paperwork with the SBWC to challenge the insurance company’s decision. The “notice of claim’’ (form WC-14) is good for one year after your injury or last medical treatment provided and two years after your last weekly disability payment. Get used to the details and paperwork. It’s part of the process.
Mediation — You might be offered a “mediation’’ session with the insurance company to reach a settlement. In Georgia, approximately 82% of the appeals cases are solved this way instead of a hearing. But if a settlement can’t be reached, the process continues.
Hearing — It’s an informal legal proceeding that typically takes place at a courtroom in the county where the injury occurred. Your attorney will make arguments and present evidence to a judge, who will make a decision within 30 days.
Appellate Review — If you don’t like the judge’s hearing decision, your attorney can go to the SBWC’s appellate division by filing an application for review within 20 days of the ruling. The appellate division makes its decision after evaluating written arguments from both sides.
Court — If the SBWC appellate judge rules against you, there’s one final recourse. You can go to the Georgia Court of Appeals (and subsequently to the Georgia Supreme Court). Your attorney must file that appeal in the county where you were injured within 20 days of the SBWC’s final order.
Eligibility for Workers Comp in Georgia
Nearly every employer in the state of Georgia is required to provide employees with workers compensation insurance. According to Georgia law, any business with three or more workers (including regular part-time workers) must have the insurance and coverage begins on the employee’s first day of work.
There are some exceptions to coverage requirements, including railroad carriers, U.S. Government agencies, farm laborers and domestic servants.
Want to check on your workplace? Coverage can be verified by going to www.sbwc.georgia.gov and clicking on “How Do I verify an employer’s workers’ compensation insurance coverage’’ or by checking through this database.
Benefits: What Does Workers Comp Cover in Georgia?
There are three major categories of benefits in Georgia’s workers compensation laws — medical, lost wages and death benefits — with several sub-categories that help determine how much you might receive and for how long.
Here is a look at each category of benefits and the sub-category that influences how much is paid out and for how long.
In Georgia, you are required to use one of the six doctors offered by the company. It’s your choice and you can switch that option once. In that circumstance, the insurer must pay all of your medical bills as long as the doctor says the treatment is for your job-related injury. If you receive weekly benefits, you have the right to ask the SBWC to be examined by a doctor you choose.
When you’re hurt on the job, it’s in everyone’s best interest — the business owner, fellow employees, insurance carrier and certainly you — to get well and return to work. Paying medical costs to achieve that goal is the foundation of workers compensation.
Medical benefits typically covered by workers comp in Georgia:
- Physical therapy
- Occupational therapy
- Psychological and mental health treatment for PTSD, depression or anxiety due to your work injury
- In-home nursing and attendant care
- Chiropractic services
- Emergency room care
- Hospital visits
- Diagnostic tests
- Prescription medication
- Prostheses, braces and assistive devices
In the case of a catastrophic injury, benefits could also include:
- Job search assistance
- On-the-job training
- Payment of education expenses
- Assistance with your resume and interviewing skills
You must play by the rules, though. Some suggestions you should follow:
- Don’t skip appointments.
- Don’t go to your private doctor and expect to be reimbursed.
- Don’t pay a bill for treatment that is sent to you (send to the employer or insurance carrier).
- If you go to the emergency room, tell the staff you were hurt on the job.
- Give them your company’s name and phone number or the number for the insurance company that handles workers comp for your company.
If there’s any doubt about what you should be doing, contact the claims adjuster from the insurance company. There’s always going to be debate on what is truly necessary and you don’t want any unnecessary expenses.
Lost Wage Benefits
The bills still must be paid, even when you’re out of work. But in Georgia, the lost wage benefits are among the nation’s lowest for workers compensation.
As of July 1, 2019, the maximum benefit for an injured Georgia worker was two-thirds of the weekly salary up to a maximum of $675 (an increase of $100 from the previous era). That figure is ranked 46th in America.
“When it was $575, we were 49th, right behind Mississippi, so now we’ve skyrocketed,’’ Holder said. “Look, we were glad it went up. It’s more money. But it also represents how much we are lagging.
“Unfortunately, this is a very unique situation in Florida. Florida has a maximum rate that is indexed each year, based on the per capita income in the state. We wish we had that. We did go up, but it’s still a flat number, not an index.’’
Here’s a look at the various sub-categories for the lost wage payments.
Temporary Total Disability Benefits
This is the maximum benefit (up to $675 weekly). You qualify if that doctor says you can’t work at all or if they put you on “light work duty’’ (and there’s no light duty available).
Once you’re out of work for a week (the “waiting period’’), you can start drawing weekly checks for lost income. If you’re out of work for 21 days, you can get paid for the waiting period as well.
For injuries after July 1, 1992, the benefits and medical insurance continue for a maximum of 400 weeks from the date of injury. If you have a catastrophic claim, you could receive lifetime benefits. In the case of light duty work release, the benefits could be limited to 52 consecutive weeks or 78 total weeks (in which case they would be reduced to temporary partial benefits).
Temporary Partial Disability Benefits
Temporary partial disability benefits are payable when your doctor says you can go back to work, but only for limited duty with some restrictions. It applies because you are making less per hour or because you are working fewer hours.
The weekly TPD benefit is equal to two-thirds of your average weekly salary up to a maximum of $450 per week. The TPD benefits last for a maximum of 350 weeks from the date of the accident.
Permanent Partial Disability Benefits
PPD claims are by far the most common type of workers compensation claim (accounting for more than half of all cases nationwide). It can be the result of a work-related injury or an occupational disease. In Georgia, these benefits can be claimed only if there are no TTD or TPD benefits being received.
PPD benefits are two-thirds of the weekly salary up to a maximum of $675. They are calculated by multiplying the percentage of impairment rating given by the doctor by the number of weeks allowed under the law depending on the type of injury that you have.
In Georgia, the maximum weeks allowed for PPD benefits are as follows for each body part:
- Thumb (60 weeks)
- 1st (index) finger (40)
- 2nd (middle) finger (35)
- 3rd (ring) finger (30)
- 4th (little) finger (25)
- Arm (225)
- Foot (135)
- Leg (225)
- Eye (150)
- Great (big) toe (30)
- Other toes (20)
- Hand (160)
- Disfigurement (none)
- Disability/whole body (300)
- Hearing loss (one ear)/Total industrial (75)
- Hearing loss (both ears)/Total industrial (150)
For example, if you usually made $600 a week, 66.7% of that would be $400. Now multiply that by, let’s say, a doctor’s evaluation of 75% (0.75) use of your thumb and your weekly impairment benefit would equal $300. Based on the formula of 60 weeks for your thumb, you would collect a total of $18,000, then your impairment benefits would run out.
In Georgia, there is no benefit category called Permanent Total Disability. It is possible to get benefits for a total disability on a permanent basis for a qualifying catastrophic injury or for the loss of use of more than one major member of your body.
In Georgia, the maximum death benefit is $270,000 (two-thirds of deceased worker’s average weekly wage up to a maximum of $675 for a maximum of 400 weeks).
If a worker dies due a work-related injury or illness, death benefits are available to their surviving dependents and that includes:
- The deceased’s spouse (husband or wife)
- The deceased’s children (including stepchildren, legally adopted children, posthumous children and acknowledged children born out of wedlock, as long as they are younger than 18 or enrolled full-time in high school; younger than 22 and enrolled full-time at a college or university; or older than 18 and physically or mentally incapable of earning a livelihood.
A surviving spouse can receive weekly payments until age 65 or the maximum allowed 400 weeks, whichever is longer. If the surviving spouse remarries or cohabitants with a partner, they will no longer be eligible for benefits.
Workers compensation must also cover funeral and burial expenses (up to $7,500).
- N.A. (2020) State Board of Workers Compensation benefits. Retrieved from https://www.gerberholderlaw.com/atlanta-workers-compensation/benefits/
- N.A. (2020) Georgia Workers Benefits Guide. Retrieved from https://www.gerberholderlaw.com/atlanta-workers-compensation/benefits/
- N.A. (2020) Georgia Workers Statute of Limitations. Retrieved from https://www.gerberholderlaw.com/atlanta-workers-compensation/workers-comp-statute-of-limitations/
- N.A. (2020) How to Appeal Workers Comp. Retrieved from https://www.gerberholderlaw.com/atlanta-workers-compensation/how-to-appeal-workers-comp/