An Atlanta workers’ compensation lawyer can help you win a bigger settlement in a workers’ compensation benefits case. These benefits are available to all covered employees, providing payment for medical bills and lost wages 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 but for the uninformed, if denied, they may willingly give up their rights and not fight for what is rightfully theirs.
The Atlanta personal injury lawyers at Ted A. Greve & Associates are here to help you. If you have questions about the workers’ compensation process, call our offices at (844)387-8677 and speak with one of our experienced attorneys. Their years of experience handling workers’ compensation cases means you will get expert advice and answers to all of your questions during your initial free consultation.
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.
If My Employer is at Fault for My Injury, Can a Workers’ Compensation Attorney to Sue Them?
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. Skilled workers comp lawyers will ensure that all of this said information is submitted to the courts accurately and in a timely matter.
At What Point Do I Qualify For Workers’ Compensation With My Employer?
The only requirements that you need to meet to qualify for workers’ compensation are to be working for an employer with workers’ comp insurance, to be a paid employee of that employer, and to have a work-related injury. There is no minimum time requirement that you have to be employed by that employer. You are usually covered from the first day of employment.
If you are unable to return to work because of your injuries, then you will not receive compensation for the first seven days of lost wages unless you are out of work for 21+ days. You can also receive compensation for your medical treatment, prescriptions, recovery and rehabilitation, and even the mileage for traveling to appointments for your injuries.
What Is Maximum Medical Improvement?
Maximum Medical Improvement (MMI) is the term used to express that your doctor has determined that your injuries will not improve any further. This could mean that you are entirely recovered, or it could mean that you have simply recovered as much as you ever will, and there is nothing more that can be done for you. If you are permanently partially or fully disabled, then your physician will assign a disability number. You will then be eligible for Social Security and disability benefits in addition to your workers’ compensation.
If your injuries keep you from working, then you may be eligible for disability payments. This will come in payments that are about 2/3 of your usual weekly pay. If you cannot earn the same wage while injured, then you may receive temporary partial disability payments at 2/3 the difference between your former and current wages. You can only receive this form of disability payments for 300 weeks from the date of your injuries. If you must endure amputation or find yourself unable to use a particular part of your body due to your injuries, then you may receive permanent partial disability payment. Some injuries even correspond to a set benefit amount.
If you lose your ability to complete your job duties and cannot completely recover, then you may also receive permanent disability payments. Total and permanent disability would apply to situations like losing both hands, both arms, both legs, or both eyes. In situations like this, you can receive disability payments for the rest of your life.
Receiving Workers’ Compensation After You Have Been Fired
Even if you have been fired as an employee from the place where you were injured, you may still be entitled to receive workers’ compensation benefits. According to the Georgia State Board of Workers’ Compensation (SWB), injured workers are eligible to receive benefits for up to 400 weeks after the accident date. If your injuries were catastrophic, you may be able to receive lifetime benefits. In most cases, you are entitled to these benefits regardless of whether or not you remain on the job.
Steps to Filing Your Claim
Anytime you are injured on the job or become ill due to workplace conditions, you need to let your employer or supervisor know immediately and seek medical attention. Even if you suspect your injury or illness is relatively minor, failing to notify your employer and neglecting to get prompt medical care could endanger your rights to receive benefits through workers’ compensation. Once you have reported your injury, the following steps should be taken as outlined by the Georgia State Workers’ Compensation Board (SWB):
- In the immediate aftermath of an accident, you will be referred to a Posted Panel of Physicians from which you should receive treatment, and notified of the Employee Bill of Rights.
- Your supervisor will ensure that a form WC-1 detailing the incident is sent to the person designated for your company by the SWB, so that your claim may be investigated.
- You will be provided with a copy of form WC-14 to provide additional details on your accident and injuries, which you will need to fill out and return to the SWB;
- You are also required to furnish a copy of the completed form to your employer and their workers’ compensation insurance representative;
- While you are waiting for your benefits to be approved, continue attending all medical appointments and treatments your doctor prescribes.
Be sure to check back with your employer as well as with the SWB if you do not receive information about your benefits within two weeks. If your employer fails to follow any of the above steps or you receive notice that your benefits have been denied, you may wish to consult with an experienced workers’ compensation attorney who can assist you with your claim.
Third-Party Liability Claims
In a workers’ compensation case where there is another entity, other than the employer, who contributed to the injuries of the employee, this is a third party; and a third-party liability claim is a claim made by the employee against this third party.
An example of a third-party liability claim would be a delivery truck driver in an auto accident where the other person was at fault. The truck driver can pursue a workers’ compensation claim with the insurance company of his or her employer (the injury occurred in the scope of employment), and can also pursue a third-party liability claim with the at-fault driver.
Another example of a third-party liability claim would be an employee working on a machine that has a defective part, ultimately leading to injury. Because the injury occurred in the scope of employment, there is a workers’ compensation claim. Because the injury was caused by a defective part, produced by a third party, there is a third-party liability claim, too.
The Primary Difference
The primary difference between a workers’ compensation claim and a third-party liability claim is in the purpose of each. Workers’ compensation provides financial compensation and medical coverage for any and all injuries related to employment. The employee agrees not to pursue a lawsuit in exchange for these guaranteed benefits. Workers’ compensation will not cover long term income loss, permanent disability, or pain and suffering. A third-party liability claim, on the other hand, is entirely separate from workers’ compensation and more damages can be recovered.
Third-Party Liability Claims Process
If you wish to pursue a claim against a third-party, you need to file the claim against his or her insurance company or file a lawsuit. The workers’ compensation claim will not affect your third-party liability claim. You will need to prove that the third party was negligent, that he or she owed ad duty of care to you, breached that duty, and thus caused your injuries and damages. An attorney will be able to represent you and will work to prove the validity of your claim.
What Are Subrogation Claims?
Subrogation claims are those made by the employer’s insurance company to recoup the payments that they have made when you file a third-party liability claim. This means that any settlement or judgment that you receive will have a lien on it to cover the payments already made by your employers’ workers’ compensation insurance. It also means that you and your employer must both agree on any potential settlement agreement. After reimbursing your employer and paying your attorney’s fees, you would receive the remainder of the award.
When a subrogation claim exists, the third-party liability claim can become more complicated and challenging to prove, and it is best to enlist the service of a qualified workers’ compensation attorney to help you achieve a successful outcome.
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 “any 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 the third party for personal reasons or injuries related to alcohol or drug abuse.”
An Atlanta workers’ compensation lawyer with Ted A. Greve & Associates can help combat allegations of willful misconduct should the need arise.
Can I Go to My Doctor for Treatment after a Job Injury?
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 Compensation Can an Atlanta Workers’ Compensation Lawyer Win in a Lawsuit?
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 job site. 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.
What if I Can No Longer Work?
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 that have lost a family member due to a workplace injury. The benefit is currently available to the victim’s current spouse and dependents under wrongful death statutes. 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. Speak with our experienced workers’ comp lawyer at Ted A. Greve & Associates to learn more.
What Types of Injuries are Covered by Worker’s Compensation
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. Even something like a truck accident may be eligible for workers’ comp.
Challenges to an Atlanta Workers’ Compensation Claim
All of Ted Greve’s workers’ compensation attorneys 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 denial:
- The 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
- The employer claims you were engaging in willful misconduct at the time of the injury
- The 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.
To make sure that your workers’ compensation claim goes as smoothly as possible and to ensure the likelihood of you winning your claim, it is best to seek out the skills of a professional and experienced Atlanta workers’ compensation lawyer who will ensure to fight for your rights and take the best legal steps for you.
Should I Start Searching for a Workers Comp Lawyer if My Employer Denies My Claim?
If your employer denies your claim, you have options, such as reaching out for legal advice from Ted A. Greve & Associates workers’ comp lawyers in Atlanta to appeal 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 the 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 One of Our Atlanta Workers Comp Lawyers Today
Georgia’s workers’ compensation laws can be very complex in nature. However, by working a knowledgeable workers compensation attorney throughout the process, you can help ensure a seamless and low-stress experience. To get started, contact an Atlanta workers’ compensation lawyer with Ted A. Greve & Associates as soon as possible. They will speak to you free of charge and let you know the best course of action to take in your case. Our lawyers are available 24/7, so don’t waste another minute, call our offices today at (844)387-8677.