Workers Comp in Atlanta

Atlanta is a busy place. It’s the home of corporate giants like Coca-Cola, Home Depot, CNN, Chick-fil-A, Delta Airlines and United Parcel Service.

It has the largest passenger airport in the world, bringing 107 million people a year to a city that hosts major business and political conventions, Olympic Games, Super Bowls, college sporting events … you name it. The city’s connectivity to interstate systems, rail lines and air cargo makes it a magnet for motivated workers.

Everything about Atlanta says big and progressive.

Everything except its workers compensation laws, which scream “WATCH OUT!”

If you are hurt on the job in Atlanta, the maximum workers compensation payout is $675 per week, or just about enough to cover the cost of rent and food for a two-bedroom apartment.

If you get hurt, you don’t get to choose your own doctor. Your employer provides you a list of six doctors they’ve chosen. You may select one of theirs.

And good luck trying to find an exceptional workers comp attorney to represent you.

“It’s like trying to buy a house where everyone is representing the seller.” said attorney Thomas Holder, who has been representing injured workers in Atlanta for 40 years. “There are many people who work in the workers compensation field every day, but they all represent the other side. You can do your research, but all the people you come across with expertise, they work for the other side.”

Holder made it clear that workers do need representation.

“Yes, you should hire a lawyer,” he said, “but by all means, first of all, just call a lawyer. Even if it’s a case they don’t want to take on, they can explain things.

“And in workers compensation, there’s a lot to explain.’’

Holder said he’d find things a lot easier to explain if Atlanta’s workers comp payout wasn’t mired at $675 per week. He’d find it more palatable if an injured Atlanta worker could pick their own doctor.

“The company-provided doctor is like the team doctor who is looking out for the team’s best interests,” Holder said. “They’re looking to get you back on the field. You have to look out for your best interests because nobody else is going to do that in the manner you need.’’

Read more about: Workers Comp in Georgia

Reasons to Hire an Atlanta Workers Comp Attorney

There are more than 150,000 business stretched over metropolitan Atlanta’s 8,376 square miles. Those businesses employ almost 2.8 million people and accidents do happen.

Most of the people who get hurt, wonder if they need a lawyer to get all the benefits promised by law.

“Yes, you definitely should hire a lawyer,” Holder said, then quickly threw an addendum on his advice. “But first of all … just call a lawyer. Even if it’s a case the lawyer doesn’t want to take on, at least they can explain how things are supposed to go … and believe me, there’s a lot of explaining to do with workers compensation.”

A few things workers need to know are signs that your case is serious enough to require legal representation include:

• If the injury is going to prevent you from returning to the job you had
• If you’re worried that filing a claim is going to cost you your job
• If you the back injury you had suddenly becomes back surgery and things are getting tense with the employer or carrier
• If the insurance carrier drags its feet approving a treatment
• If your employer says he’ll pay all the bills and you don’t need to file a claim
• If the carrier proposes a settlement and you don’t know the real value of your case.

“You’re in a game where you don’t know all the rules,” Holder said. “You need somebody that will guide you through the system; explain what’s happening now and tell you what to do next. ”

What Does a Workers Comp Lawyer in Atlanta Do?

The legal system in Georgia, like the legal systems in 49 other states, is not for amateurs. There are deadlines, processes, laws, precedents, and many other aspects that go into presenting a case before a magistrate.

And you’d better know what you’re doing with all of it.

“Do you know what the rules of evidence are in a workers comp case?” Holder asked. “Do you know what doctors to call as expert witnesses? Do you even know what the rules are for choosing medical providers? There’s a lot of things you have to know to be successful with a workers comp case.”

Just a few of the things an experienced attorney does for a case are:

• Know the specific aspects of the law that apply to your case and be able to present them persuasively in a courtroom
• Know the judges and opposing attorneys and how they react in courtroom situations
• Prepare witness testimony and have the list of questions needed to cross-examine the other side’s experts
• Know the value of your case so if a settlement offer is made, you are getting a fair deal
• Know how to handle a case if the worker doesn’t expect to get his job back

“For most workers, it’s the first time they’ve ever been involved in a workers compensation case and they’re going up against a bunch of professionals that have been doing this for years,” Holder said. “You need someone who knows they system and can help you navigate it successfully.”

How Does a Workers Comp Lawyer in Atlanta Get Paid?

Workers compensation attorneys in Atlanta are paid on a contingency basis, meaning they must get a settlement or obtain benefits the worker previously wasn’t receiving, in order to be compensated themselves.

The attorney must pay for things like medical reports, expert witnesses, any investigative work and whatever other costs go into the preparation of a case.

The attorney is reimbursed for those expenses, but again, only if he/she wins the case.

Georgia law limits the attorney’s fees to 25% of the weekly benefits or settlement obtained in a case. The attorney also will receive 25% of indemnity benefits (money paid the worker), if those indemnity benefits were not being paid when the case began. The attorney must be able to prove the worker received the benefits because of the work the attorney did.

Attorneys also can be paid by consent order, meaning both sides agree to resolve the dispute without going to court. The consent order includes an estimation of the attorney’s fees and must be approved by State Board of Workers’ Compensation.

The final way an attorney in Atlanta can get paid is if the judge determines that the defense lawyers presented a case without reasonable grounds. The judge can then award the worker’s attorney compensation that must be paid by the opposing side.

Handling a Workers Comp Case on Your Own in Atlanta

Most claims do not require the help of a workers comp attorney. When the system works as intended, you simply have to notify your employer to kickstart the process of filing a workers compensation claim. If things do not work out in your favor, you have the option to appeal a claim denial. This will require the help of a workers comp lawyer, but for reference, the step-by-step guide is detailed below.

Filing a Workers Comp Claim in Atlanta

When you file a claim in Atlanta, getting the initial form processed and knowing how workers comp works is vital. You can’t let any details slip through the cracks.

The injured employee, the employer and the insurance carrier are the principal players.

1. Injured worker notifies employer – Employee has a 30-day deadline to notify his/her employer.
2. Insurance carrier investigates the claim – Workers comp will not provide benefits for injuries resulting from misconduct.
3. Insurance carrier files a First Report of Injury – Copies will be sent to the State Board of Workers Compensation, the employee and the employer.
4. Injured worker receives the workers comp brochure – The brochure is sent by the insurance company, and it contains information about the rights, benefits and procedures for obtaining workers comp benefits.
5. Appealing a claim denial – Employees have the option to appeal if their claim is denied.

Filing a Workers Comp Claim for an Occupational Disease

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 for an occupational disease more than seven years after your last exposure to the work hazard.

How to Appeal a Workers Comp Denial in Atlanta

There are specific avenues you must follow if your claim has been denied in Atlanta and you want file an appeal.

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. 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

If the Board orders you to appear for mediation, you are required to attend. Georgia has 15 mediation sites scattered all over the state, including one in Atlanta. 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.

Phone: (404) 656-3818
270 Peachtree Street, NW
Atlanta, GA 30303-1299

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 Atlanta

Nearly every employer in Atlanta 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 Atlanta?

There are three major categories of benefits in Atlanta’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.

Medical Benefits — In Atlanta, 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 have you get well and return to work. Paying medical costs to achieve that goal is the foundation of workers compensation.

Lost Wage Benefits — The bills still must be paid, even when you’re out of work. But in Atlanta, the lost wage benefits are among the nation’s lowest for workers compensation.

As of July 1, 2019, the maximum benefit for an injured Atlanta worker was two-thirds of the weekly salary up to a maximum of $675. That is an increase of $100 from the previous era, but the state-of-Georgia ranks 46th in maximum benefits in the U.S.

“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. 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).

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 (slightly less than seven years) 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 Atlanta, these benefits can be claimed only if you are not receiving TTD or TPD benefits.

PPD benefits are two-thirds of the weekly salary up to a maximum of $675 a week. 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.

Death Benefits — In Atlanta, 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). Workers compensation must also cover funeral and burial expenses (up to $7,500).