Workers Comp in Macon

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The start of a new decade has been good for business in Macon with high-paying jobs in several industries moving to Central Georgia, making it a great place to work.

As long as you don’t get hurt.

If you’re injured on the job in Macon – or anywhere else in Georgia – and file a claim for wage compensation benefits, you receive two-thirds of your weekly wages … as long as you don’t make more than $1,012 a week.

Any worker making more than that is “capped” by Georgia law that says the most you can receive in workers compensation wage benefits is $675 a week.

Two-thirds of $1,012 is exactly the $675 limit

Two thirds of $1,013? Sorry, but that is $675.67 and over the limit that Georgia lawmakers set for workers compensation wages.

So, if you’re a driver for one of the delivery services in Macon – or anywhere else in Georgia – and you make a nice living at $1,500 or maybe even $2,000 a week, you’d be losing between $325 and $659 a week if you get hurt. If your weekly wage is higher, you lose even more.

“It’s almost like you can’t afford to go on workers comp because you’re going to take a huge hit in the paycheck,” said Thomas Herman, a workers compensation attorney and partner at the law firm of Westmoreland, Patterson, Mosely and Hinson in Macon.

“We all know the goal of workers comp is to restore injured workers to full employment and tide them over financially so they don’t starve to death, but the cap on wages really restricts workers, especially the ones who have high-salary jobs.”

Herman has been arguing this point with Georgia lawmakers for most of his 36 years practicing workers comp. He’s tried to convince legislators to tie compensation to the worker’s average weekly wage, but they aren’t listening. They voted in 2019 to increase the cap $100 a week, but it hardly meant anything. Georgia moved from 48th lowest wage compensation in the nation to 45th.  

“We’re supposed to be one of the best states for business in the country, but we’ve got a workers comp system that doesn’t keep up with the wages people are making these days,” Herman said. “Part of being a good state for business is having a good benefits package for workers. If you come here to work, you want to know that, God forbid, if something happens and you get hurt on the job, the system is going to take care of you.

“Georgia’s workers compensation system doesn’t.”

Reasons to Hire a Workers Comp Attorney in Macon, GA

The subject of workers compensation rarely comes up at a work site … until somebody gets hurt.

“I can’t tell you how many times an injured worker comes into my office or calls me on the phone and asks: ‘What are my rights? What benefits do I qualify for?’ “ Herman said.

Fortunately, they have come to the right place. Workers compensation attorneys know far more about benefits, and the steps to take to claim them, than the injured worker.

So do the insurance carriers who pay the claims and they’re not exactly generous with money and what it takes to get it.

If you visit with a workers compensation attorney, they spend much of that first meeting – called a “consultation” and free to any injured worker – educating workers on what benefits they are entitled to.

Here are just a few of the signs you might need an attorney to plead your cause.

  • Medical treatment is delayed or denied
  • Calculations for wage compensation are not accurate
  • Employer says he’ll pay the bills if you don’t file a claim
  • There is a dispute over whether the injury was work related
  • Work restrictions ordered by doctor are being ignored
  • Access to a second doctor for treatment is disputed
  • Right to independent medical exam (IME) is disputed
  • Doctor not willing to treat multiple body parts.
  • 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

“The average lay worker doesn’t’ know the laws dealing with workers compensation, but you can be sure the insurance carrier does and they’re going to take advantage of that,” Herman said. “If something doesn’t seem right with how your case is being handled by the insurance company, it probably isn’t. That’s why you ask an attorney.”

What Does a Workers Comp Lawyer in Macon Do?

The original idea for workers compensation – pay for medical treatment and compensate the injured worker for lost wages – has all but been lost as laws are amended and rewritten to suit whatever party is complaining the loudest.

The result is a complicated system of rules and regulations that, if you’re not experienced in dealing with them, can cost you dearly.

Here are a few of the things a workers compensation attorney does that a worker either wouldn’t know they could do, or wouldn’t know how to do.

  • Depose accident witnesses and insurance claims adviser
  • Obtain all necessary medical documents
  • Know what questions to ask that can change the outcome
  • Conduct settlement negotiations with the insurance carrier
  • Know how to present the evidence in an understandable and compelling way
  • Know the case law that supports the injured worker’s case
  • Know who the expert witnesses are and when to call them
  • Know how to file an appeal, if necessary
  • Know how the injury affects the worker’s ability to return to the job now, or anytime in the future
  • Know how to successfully calculate lost wages

“You’re up against people who know the rules, know how to manipulate the rules to try and turn things to their advantage,” Herman said. “It really is an uneven playing field and that’s why you need an attorney.”

How Much Does a Workers Comp Lawyer in Macon Charge?

Maybe the biggest misunderstanding in workers compensation cases is that the injured worker can’t afford an attorney.

The truth is, it won’t cost anything to hire an attorney to argue your case.

Georgia workers compensation lawyers are paid on a “contingency” basis, which means they are compensated only if they recover an award for the worker. There is no retainer fee or hourly rate involved.

The first meeting to discuss the case is called a consultation and that is free. The injured worker tells his/her story and the attorney advises them what benefits they may be able to claim and whether they actually need an attorney to proceed with the case.

In nearly every case, the injured workers do better if they are represented by an attorney.

“My job is to make sure the injured workers receive all the benefits available to them,” Herman said. “Our being compensated is directly tied to our ability to present the case in the best possible light so the worker gets those benefits.”

In return, the attorney receives 25% of the benefits they recover for the worker. If the facts allow it, the attorney asks that the insurance carrier pay the 25% fee on top of any benefits awarded at a hearing.

At the end of the day, the attorney fees have to be approved by state board of workers compensation.

“Attorneys advance the cost of the paperwork for filing, the time spent taking depositions and recruiting witnesses and experts and any other costs associated with obtaining a successful outcome for the case,” Herman said. “It just makes more sense to at least get a free consultation and let us evaluate your case.”

Handling a Workers Comp Case on Your Own in Macon, 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 Macon

When you file a claim in Macon, 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 Macon

There are specific avenues you must follow if your claim has been denied in Macon 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 Macon. 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.

Employee Assistance Office

Phone: (478) 471-2051
110 Holiday Drive North
Suite A
MaconGA 31210-1802

Directions to the Macon Mediation Site:

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 Macon

Nearly every employer in Macon 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 Macon?

There are three major categories of benefits in Macon’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 Macon, 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 Macon, the lost wage benefits are among the nation’s lowest for workers compensation.

As of July 1, 2019, the maximum benefit for an injured Macon 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 Macon, 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 Macon, 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).

Sources:

About the author

Bill Fay has touched a lot of bases in his 45-year career. He started as a sports writer, gaining national attention for work on college and professional sports. He had regular roles as an analyst on radio and television and later became a speech writer for a government agency. His most recent work is as an internet content marketing specialist. Bill can be reached at bfay@workerscompensationexperts.org.