The Masters, maybe the most popular golf tournament in the world, might be what put Augusta on the map, but there is far more to Georgia’s second-largest city than a great golf course.
Augusta is home to a vibrant healthcare industry that includes the state’s only public teaching hospital. There also are manufacturers, warehouses, agricultural interests and an enormous nuclear reactor plant next door in Burke County.
All of which, makes Bryan Hawkins a very busy man. Hawkins has been a workers compensation attorney in Augusta for 12 years and has watched the city transition from an industrial economy to service-oriented business.
The one common thread between them – people get hurt on the job. And there are plenty of places to go for treatment – 14 hospitals are located within a 25-mile radius of Augusta – and plenty of expert medical personnel, who also get hurt on the job.
Hawkins sees every level of healthcare employee from nurses that get back injuries lifting patients to critical care employees in emergency rooms or retirement nursing homes. The medical industry accounts for nearly 20% of the employees in Augusta and that’s a blessing for injured workers in the area looking for quality treatment.
“We have access to a lot of medical experts who can really help us make our case when a worker gets injured,” Hawkins said.
It’s also a double-edge sword. Lawyers for the insurance companies spend a lot of time with those same doctors trying to get them to take their side in a claim.
“The insurance lawyers try to bully doctors into saying something or signing something that maybe ethically, the doctors don’t want to say or sign,” Hawkins said. “We have a lot of really good doctors who won’t take workers compensation cases because they don’t want to deal with the hassle of waiting on claims adjusters to approve treatment or dealing with insurance lawyers who want them to take unreasonable positions on what caused an injury.
“The doctors are tired of it, and I don’t blame them.”
The situation in Augusta has gotten so contentious at times that it may require the Georgia State Board of Workers Compensation getting together with the Medical Association of Georgia and coming up with a better work situation for both sides.
“I can see why some doctors just throw their hands up and say ‘I’m not dealing with this anymore,’“ Hawkins said. “We need to find a way to make doctors happy about taking on workers compensation cases and giving the injured workers a voice in how they get treated.”
Signs You Need a Workers Compensation Attorney in Augusta
It is not uncommon for an injured worker to have to wait for approval of medical treatment for workers comp. Stalling on decision-making is one of the tactics insurance companies use to avoid paying the bills for treatment.
“A lot of times, the insurance industry hopes if they stall long enough, the injured worker will give up and use and their own health insurance to pay for treatment,” Hawkins said. “The delays make workers worried that they will lose their job if they complain about it. It’s tempting for them to say ‘OK, I’ve got this job and a mortgage and a car payment and kids in school, I have health insurance and I won’t get in trouble for using that, so let’s just go that way.’ “
If the insurance carrier delays any medical treatment, it’s a huge sign you will need an attorney to handle your claim. Some of the other obvious signs that it’s time to get legal help include:
- You are not sure of your rights and what benefits you are entitled to
- Calculations for missed wages are inaccurate so you receive less than what is owed
- There is a dispute over whether the injury was work related
- Employer tries to get involved in claim by calling you or your spouse to discuss it
- Employer starts treating worker poorly because they filed a claim
- Insurance carrier claims injury is not compensable because of pre-existing condition
- Time limit for non-catastrophic injury is coming up and carrier says they will close the book on benefits
- Right to independent medical exam (IME) is disputed
- Doctor not willing to treat multiple body parts.
- Parts or all of the claim are being denied
What Do Workers Compensation Attorneys in Augusta Do?
One of the first questions injured workers should ask themselves is: Do I know workers compensation laws well enough to handle this claim on my own?
It is a certainty that the insurance company’s attorneys do and unless the injured worker practices this type of law regularly, it’s also just about a certainty that they don’t.
“There are rules involved in workers compensation and exceptions to the rules and exceptions to the exceptions in the rules,” Hawkins said. “If you go into court without expert knowledge and carefully written opinions, you are going to lose.”
Those are just two of the things you should expect a workers compensation attorney to do. Here are a few more things they do that will tilt the outcome in favor of the injured worker:
- Know how to get all pertinent medical records for the case
- Know the questions that need to be answered to build solid case
- Get doctors involved in medical treatment to write a medical narrative that presents injured worker’s side of the story
- Know the opposition’s witnesses and what their motivation for testifying is
- Depose both treating doctors and witnesses to the accident
- Put together a thoughtful settlement offer based on how much the employee is making, what the medical history is and what the exposure for the insurance company would look like if they don’t settle
- Schedule a mediation so the parties arrive at a settlement faster
- Knowing what is admissible evidence in a case and presenting it in a compelling way
- Know expert medical witnesses to call for testimony
- Be prepared to take the case to appeal stage, if necessary
How Much Do Workers Comp Attorneys in Augusta Charge?
Workers compensation attorneys in Georgia are paid on a contingency basis, which means they must win an award of some kind for the injured worker, or the attorney doesn’t get paid.
Georgia law says that if the injured worker wins an award – either through settlement negotiations or through a trial – the attorney can receive up to 25% of the award as compensation. All attorney’s fees have to be approved by the Georgia Board of Workers Compensation.
“So, for every dollar we get the worker, we get to keep a quarter,” Hawkins said. “And if we don’t get them a dollar, we don’t keep anything so it’s really a no-risk situation.”
There is one other way the attorneys can be paid. It’s called an “assessed fee” and it’s handed down if the trial judge feels the insurance carrier was unreasonable in denying the injured worker’s claim. When that happens, the “assessed fee” of an additional 25% of the award is charged to the insurance company, and not deducted from the employee’s award.
“It’s a penalty for the insurance company being ridiculous about not paying the claim,” Hawkins said. “It used to be very rare to get that, but it’s become a lot more fair lately.”
The final decision on whether to hire an attorney easily could be compared to the decision on whether you should go on YouTube and see if you could find a way to do the job yourself … or hire an experienced mechanic to do a job he’s done successfully many times before.
“I can’t think of a case where the injured worker wouldn’t get a better result if they have a lawyer representing them,” Hawkins said. “At the very least, workers should take advantage of the free consultation and decide where they stand on a case.”
Handling a Workers Comp Case on Your Own in Augusta, GA
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 Augusta
When you file a claim in Augusta, 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.
- Injured worker notifies employer – Employee has a 30-day deadline to notify his/her employer.
- Insurance carrier investigates the claim – Workers comp will not provide benefits for injuries resulting from misconduct.
- Insurance carrier files a First Report of Injury – Copies will be sent to the State Board of Workers Compensation, the employee and the employer.
- 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.
- 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 Augusta
There are specific avenues you must follow if your claim has been denied in Augusta 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.
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 Augusta. 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.
Directions to the Augusta Mediation Site:
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.
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.
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 Augusta
Nearly every employer in Augusta 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 Augusta?
There are three major categories of benefits in Augusta’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 Augusta, 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 Augusta, the lost wage benefits are among the nation’s lowest for workers compensation.
As of July 1, 2019, the maximum benefit for an injured Augusta 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 Augusta, 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 Augusta, 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).
- N.A. (ND) Workers’ Compensation Law FAQs. Retrieved from https://sbwc.georgia.gov/frequently-asked-questions/workers-compensation-law-faqs
- N.A. (ND) Publications. Retrieved from https://sbwc.georgia.gov/publications-and-forms/publications