Why do I need a workers compensation attorney?
Workers compensation benefits, available to all covered employees, provide payment for medical bills and lost wage reimbursement to workers who sustain on-the-job injuries or contract a work-related illness. A specific amount of compensation is available for each type of injury, depending on its severity. If you have questions about the workers’ compensation process, speak to an Atlanta workers’ compensation attorney today.
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Does fault matter in a workers’ compensation case? Fault has no effect on an employee receiving workers’ compensation benefits. An employer must award benefits for any injury as long as the employee sustains it within the scope of his employment. Even if the worker makes a mistake and directly causes his injury, the employer’s insurer must still pay.
What if my employer is at fault for my injury? Can I sue him?
Workers, by receiving workers’ compensation benefits, give up their right to sue their employer, even if their employer is at fault for the accident. The only time an employee may be able to sue his employer is if the employer showed egregious neglect or intentionally caused the injury, such as through an assault.
Employee rights and duties under the law
The Georgia workers’ compensation laws begin with a list of employee rights that apply to any person seeking benefits from his employer. In summation, these rights are as follows:
- The right to medical, rehabilitation and income benefits, including benefits for surviving loved ones of anyone who sustains fatal injuries on the job
- Payment of all necessary doctor bills, hospital bills, physical therapy, prescriptions, necessary travel expenses, and in some cases, rehabilitation costs
- Weekly income benefits
- Benefit payments for catastrophic injuries in an amount equal to two-thirds of the employee’s average weekly rate for as long as the employee is unable to return to work/unlimited benefits
- Benefit payments for non-catastrophic injuries in the same amount, up to 400 weeks
Employees must meet certain requirements and duties to receive workers’ compensation benefits. For instance, employees must report their injuries to the employer within 30 days of the incident or benefits may be unavailable. Further, workers must conduct themselves reasonably and safely while on the job and an injured worker must accept medical treatment to help mitigate the impact of the injury.
Does Georgia law require all employers to carry workers’ compensation insurance?
Under Georgia law, an employer must provide workers’ compensation coverage if the entity regularly employs three or more workers (part- or full-time). Fortunately, workers’ compensation coverage begins on the employee’s first day of work – and continues throughout the duration of the employment relationship.
Any injury an employee sustains on the job triggers coverage, so long as it is “[a]ny injury, illness, or death arising out of and in the course of employment.” This includes any assigned tasks or duties directly within the scope of employment, but does not include commuting to and from work, or injuries occurring on a lunch break.
While workers’ compensation is generally a no-fault system, coverage will be suspended in any situation in which a worker engages in willful, intentional misconduct resulting in injury. Under the regulations, “willful misconduct” includes “fighting, horseplay, willful act of third party for personal reasons, or injuries related to alcohol or drug abuse.”
An Atlanta workers’ compensation attorney from Ted A. Greve & Associates can help combat allegations of willful misconduct should the need arise.
Can I go to my own doctor for treatment?
One of the first questions posed by those who sustain injuries on the job is whether they can return to their trusted, familiar physician for treatment.
Each workers’ compensation policy comes with a pre-approved listed of doctors and specialists the insurer trusts to make an adequate and thorough assessment of the workplace injury. Workers’ compensation claimants must adhere to this pre-approved list when seeking treatment – and may be required to work with another provider if their current physician is not on the list.
As part of Georgia’s workers’ compensation laws, employers must prominently post a list of at least six doctors for workers to contact in the event of an injury. As well, the list must include at least one orthopedic surgeon. Failure to seek treatment from an approved physician will likely result in a denial of the claim for coverage.
Note: If the incident requires emergency response services, the employer must cover the costs of the initial temporary treatment at a local emergency facility.
How much will I receive?
The amount available for a workers’ compensation claimant is directly correlated to the severity of the injury. Of course, as explained above, an injured worker can expect full reimbursement for the medical costs and expenses associated with the injury – even including reasonable travel expenses in some cases. For many workers, however, reimbursement of medical expenses is insufficient to cover the entire cost of the injury – which may include significant lost time from work and other issues.
Total disability benefits are available to help injured workers facing injuries severe enough to prevent them from quickly returning to the jobsite. Under the regulations, workers missing more than seven workdays are entitled to weekly benefits equal to two-thirds of the workers’ average weekly wage.
However, if an injury causes a worker to miss greater than 21 days of work, the employer’s insurance will pay for the first seven-day period as well. Otherwise, an employer’s insurance will not pay an injured worker for the first seven days off the job.
If a worker is unable to return to work at all, his or her status will change to that of permanent partial disability. The amount of benefits available under this category will depend upon a number of factors, including a disability percentage rating (offered by the physician) and the statutory compensation rate for an individual injury under Section 34-9-263 of the Georgia Code.
Lastly, death benefits are available for surviving loved ones having lost a family member due to a workplace injury. The benefit is currently available to the victim’s current spouse and dependents. The insurer will determine the death benefit amount by calculating two-thirds of the employee’s average weekly pay.
Employees can also receive benefits if they are able to go back to work but must take a lower-paying job.
What types of injuries does workers’ compensation cover?
As stated above, workers’ compensation covers any injury a worker sustains in the scope of his employment; however, workers’ compensation benefits are also available to redress some of the less common medical problems triggered by certain types of employment.
For instance, workers’ compensation benefits are available if a worker contracts an illness – such as mesothelioma – due directly to that worker’s on-the-job tasks. To receive benefits, an illness claim must make a clear causal connection between the employee’s on-the-job tasks and the resulting illness.
Repetitive motion injuries are also compensable under the workers’ compensation statute as long as the employee’s job tasks directly caused the injury. While some injuries happen in an instant, others occur over time. For workers consistently using their hands, shoulders, or back to perform occupational tasks, pain and soreness can ultimately develop into a more serious orthopedic condition.
Challenges to a workers’ compensation claim
As workers’ compensation practitioners, we strive to make the process as simple and streamlined as possible. However, a number of challenges could possibly emerge, including a failure to meet the required deadline for notifying an employer of injury – which is 30 days from the date of the incident. Moreover, an employer could cite any of the following as reasons for a denial:
- Discrepancy between the reported injury and the medical documentation
- Evidence of alcohol or drugs in a toxicology report
- You filed the claim post-termination or lay-off
- Employer claims you were engaging in willful misconduct at the time of the injury
- Employer claims you sustained your injury off the clock
- You filed your claim late
- Your injury was preexisting
While some of these issues may be difficult to overcome, others are unfair attempts by an employer to avoid paying a valid workers’ compensation claim. For instance, there is nothing to prevent a worker from filing a claim for a valid workplace injury, even the employer terminated or laid off that worker – assuming the claim itself is valid and the worker filed it on time.
Further, discrepancies between a medical report and the reported injury may be due to some degree of miscommunication by the physician and/or employee as to the nature of the injury, and may be easy to resolve with a re-examination.
The insurer may also deny your claim if you refuse to grant it access to your medical records or if you refuse to give a recorded statement. This is wrongful denial, as you are under no legal obligation to give a recorded statement or sign off access to all of your medical records.
Note: Your employer’s insurer will need your medical records and bills pertaining to your injury; you can comply and ensure the security of your medical records by personally giving the insurer your records.
Do I have any options if my employer denies my claim?
If your employer denies your claim, you have options, such as appealing the decision. First, an employer must give an employee a detailed written explanation as to why the employer denied the claim.
If the employee disagrees with the reason for the denial, he may file an appeal with State Board of Workers’ Compensation. In order to file the claim within the statute of limitations, the employee must initiate the appeal within one year of the date of the injury.
On appeal, the claimant will likely have to participate in an administrative hearing before an administrative law judge (ALJ) who will determine whether a claim denial is appropriate given the circumstances. During an administrative law hearing, the ALJ will review the medical evidence at hand, take testimony from witnesses, and possibly ask questions of the witnesses to clarify any issues.
Note: If an employee believes he may be able to resolve the dispute without going through litigation, he may request to settle the issue through mediation.
From there, the ALJ will make a decision either affirming or denying the original decision. If a claimant is unhappy with the administrative law judge’s opinion, he may seek additional review from the State Board of Workers’ Compensation’s appellate team.
Contact a workers’ compensation lawyer in Atlanta today
Georgia’s laws of workers’ compensation can be very complex in nature. However, by working a knowledgeable Atlanta workers’ compensation attorney throughout the process, you can help ensure a seamless and low-stress experience. To get started, contact Ted A. Greve & Associates today at 800-375-9190.