Common Workers’ Compensation Questions & Answers
Below is a list of common questions about workers’ compensation, with answers directly from John Snyder:
The Workers’ Compensation Act is a set of laws administered by a state agency, known as the State Board of Workers’ Compensation. The Board governs what workers, employers and insurance companies are supposed to do when a worker is injured on the job or gets a disease caused by the job. It is usually called “workers’ comp.”
With very few exceptions, workers’ comp applies if your employer has three or more employees when you are working there. The Workers’ Compensation Act requires that employers provide two kinds of benefits to the injured employee, at no cost to the employee. The first needed benefit is the medical benefit. The second (and equally important) benefit is the income benefit. Income benefits must be paid if an employee is off work due to the work-related injury. The law covers full time, part time, and temporary employees.
Workers’ comp is a very complex area of law. I highly recommend retaining a lawyer to help file and pursue a claim. You can be sure that all employers and their insurance companies have their own lawyers. Their “in-house” lawyers do not work for anyone else except the insurance company. You need your own lawyer working for you.
This section of the web site is only intended to give you a general overview of workers’ comp and is not intended to give a legal opinion or legal advice. All legal opinions and advice require a lawyer to consider a specific factual situation in light of the governing law. This page cannot be substituted for such a legal analysis, so you should retain an experienced lawyer to work directly with you.
Yes. Workers’ comp is separate and different from your health insurance, even if your health insurance is paid directly through your employer’s plan for all employees.
“Work related” is sometimes called “on-the-job” and that is what it generally means, but not always. Most injuries covered by workers’ comp occur during an ordinary workday. All work related injuries are covered. For example, if you slip and fall at work, while you are “on the clock” that is definitely covered. If you slip and fall in the company parking lot, that might be covered. If you are working at a construction site, it is work related no matter where the construction site is located. If you are working out of town and staying in a motel, and you get hurt in the motel, it may be work related, depending upon your position with the company.
A disease is considered an on-the-job injury if the disease is the direct result of your work. Catching a cold from a fellow co-worker is not the result of your work. If you get anthrax while handling poisoned mail for your company, the anthrax would probably be considered a work-related disease.
Many work related injuries and diseases do not happen suddenly. An injury can occur over time through repetitive motion movements that some workers are required to perform, such as tightening bolts on an assembly line, using a jack-hammer, or typing on a computer keyboard. In the same way, many work-related diseases come from more than a single exposure incident. The lung diseases of asbestos workers and old time cotton mill workers were diseases that came on slowly over a period of extended exposure.
There are a variety of illnesses, trauma from accidents and occupational diseases that are considered disabilities and may entitle you to workers’ compensation or SSDI. Be sure to check our overview of Categories of Qualifying Disability. If you are not sure whether you may qualify, call us at 404-321-7733.
The most important rule for you to follow is to report to your boss as soon as possible after you have an on-the-job accident or as soon as you believe the job has somehow made you sick.
In the cases of a work-related injury, you usually must report the incident within 30 days to qualify for all workers’ comp benefits. For example, if you strain your back at work, but decide that you can go on working you might wait to report your injury. But, why wait? If you report the incident right away and show your boss how you hurt yourself that will tend to nail down just when and how the accident happened. Your boss will know the back strain occurred at work and not after you got home. Your report does not need to be in writing. You don’t have to prove that your employer was negligent or knew that a part of your job was dangerous. You can’t be penalized because a fellow employee caused the accident. The only important question is whether your injury or illness is work-related.
Again, some injuries and almost all diseases take time to develop. The Workers’ Compensation Act recognizes this, but you still need to report to your employer as soon as you realize that you have a work-related injury or illness.
Missing the workers’ comp reporting deadline may also affect your health insurance. Some insurance plans will pay nothing for a work-related injury or illness. In other words, to delay reporting a work-related injury or illness, may also cause problems in obtaining coverage with your regular health insurance plan.
The Workers’ Compensation Act is designed to give you the medical care you require. Medical benefits are the most important benefit for the injured worker.
Once you have told your boss that you have been hurt at work, or the job has made you sick in some way, you have done enough to give the employer “notice” of an injury. After that, the employer should take steps immediately to get you to a doctor.
The law states that the employer is entitled to name the doctor(s) who will treat you for the work related injury. The employer’s list of doctors is called the Panel of Physicians. If, for any reason, the employer does not allow you to see a panel physician, you should go to a doctor or hospital of your own choosing and get treatment. Tell that medical provider you have been hurt on the job. If your injury is found to be work related, then the employer must pay for the medical care you received, even though it was not provided by one of their “panel” physicians.
The quality of medical care you receive from some panel physicians may seem to lean in favor of the employer when it comes to their opinions about the cause and severity of your condition. Therefore, if you have any doubts about the diagnosis or the treatment you receive from a panel physician, I recommend strongly that you obtain a second opinion regarding the cause and severity of your injury. Your lawyer can help you obtain a second opinion with a different physician. Depending upon your individual case and circumstances, sometimes your lawyer can help you see another doctor, entirely independent of the employer’s panel; and the employer/insurer will have to pay for that evaluation.
Again, depending upon your individual case and circumstances, you may qualify for one or more of the three types of income benefits. Income benefits are based upon your average gross weekly wages, but they are always at least 1/3 lower than your average weekly wage.
* Temporary Total Disability (“TTD”) is paid if you must miss more than 5 consecutive work days. In Georgia, weekly total disability benefit payments are equal to two-thirds of your average weekly wage up to the maximum of $525.00 per week, if you were injured after July 1, 2013. If you were injured before July 1, 2013, the maximum benefit payment you are entitled to receive is $500.00 per week. You will need a doctor’s excuse stating that (due to your work injury or illness) you cannot return to work for the days you will have to miss. Do not miss work without a doctor giving you a written excuse to do so; that could jeopardize your job. * Temporary Partial Disability (“TPD”) is paid if the doctor finds that you can only return to work on a “light duty” or “restricted duty” basis and, because of that restricted duty, you earn less money than you would ordinarily have earned while working full duty. Again, a doctor must provide a written light duty restriction. TPD benefits are calculated at two-thirds of the portion of salary loss due to your job injury and subsequent work restrictions. * Permanent Partial Disability (“PPD”) is a benefit payment for a work-related injury or illness that leaves you with a permanent partial disability. A doctor is the only one who can determine if you qualify for a permanent partial disability payment.
Some injuries are known as “catastrophic” injuries and if your injury is deemed catastrophic, then the weekly “cap” on income benefits does not apply. However, those injuries are unusual, very severe, and complicated. I do not address catastrophic issues on this page. However, I will be glad to explain that type of injury or illness personally, either at my office or on the phone.
In Georgia, income benefits accrue only after you have missed five consecutive work days due to a work-related injury or illness. On the sixth working day, the employer’s workers’ compensation insurance policy begins to owe you income benefits. Income benefit amounts are calculated differently for TTD, TPD and PPD and they have different periods of time (or caps) for which they might have to be paid. In addition, every injured worker’s situation is different and no two injuries are exactly alike. Therefore, it is very hard to determine with precision exactly how much money one injured worker may eventually be paid as opposed to another injured worker.
Generally, however, the main income benefit (TTD) can be calculated as follows: If you earned more than $787.45 per week before your injury, and you were hurt after July 1st, 2013, then the TTD you would be paid would be $525.00 per week, for all the weeks you are unable to work. If you earned less than $787.45 per week before your injury, (and the injury was after 7-1-13), then your TTD benefits would simply be equal to two-thirds of your average weekly wage. TTD rates for injuries sustained before July 1st, 2013 are lower than for injuries that occurred after July 1st, 2013.
Regardless of your average weekly wage and calculated compensation rate for TTD, those benefits are payable after the first week you cannot work. The maximum number of weeks you can get TTD payments is 400 weeks. You are entitled to receive TTD benefits as long as you remain unable to return to work. If the doctor returns you to work “light-duty” (and your employer cannot provide you work within those restrictions) then you would still be entitled to TTD payments. This is a tricky area of workers’ comp and you should consult with your lawyer if you are being pushed back to work before you are ready.
The second money benefit, TPD benefits, are paid during the period you are confined to light duty restrictions and the restriction results in a partial loss of income. TPD benefits are calculated at two-thirds of the partially lost income. The maximum number of weeks you can be paid TPD is 350 weeks, and the most money you can receive in TPD payments is $350.00 per week, for injuries after July 1st, 2013.
PPD benefits are calculated on a percentage basis. In other words, what is the percentage of loss, or function, of one or more parts of your body? Permanent partial disability ratings, or measurements, are provided by the injured workers’ authorized treating physician. The doctor must use the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition in order to give you a “rating.”
If you are dissatisfied with how your case is being handled by either the company or their insurance company, then you (or your lawyer) must file a “claim” with the State Board of Workers’ Compensation asking a Judge to straighten out the problem. Filing a claim may be the most important decision you make. You should always consult a lawyer before taking this step.
Most importantly, a “claim” must be filed within certain time limits, known as the “statute of limitations”. In Georgia, a claim for some benefit under the Workers’ Compensation Act must usually be filed within one year from the date of the work-related injury. The one-year limit is subject to several exceptions and your lawyer can advise you about the exceptions.
Formal hearings are required when the employee and the employer cannot reach agreement on issues that are related to your work-related injury. Hearings are held at many locations around the state. The arguments of the employee and the employer are “heard” by administrative law judges in the workers’ compensation system. The judge who hears your case makes his/her decision after listening to all the evidence presented at the trial.
The hearings are much like courtroom trials, except there are no juries in workers’ comp cases. Normally, lawyers for both sides make opening statements to the judge. After that, witnesses (such as a co-worker or a relative, etc.) are called to testify and tell the judge what they know about your claim. After the trial, the judge allows each lawyer to file “briefs”, which are post-hearing arguments in writing. The administrative law judge then makes a final decision and prepares a written award. The decision making process may take several months. An appeal of the judge’s award is allowed by either party if the party is dissatisfied with the judge’s award.
About 95% of all workers’ comp claims are resolved through a settlement. In other words, about one claim in twenty actually goes to “trial” at the State Board of Workers’ Compensation. This does not mean that you have to settle. If you ever hear anyone guarantee a favorable settlement, then whoever makes such a guarantee is likely to recommend too low a settlement, which is not in your best interest.
Agreements for settlement are usually for a lump sum dollar amount. The injured worker, or claimant, gets a lump-sum dollar amount all at one time, which is attractive if you, the claimant, will be able to recover and get back to some kind of suitable work. Also, workers’ comp cases sometimes settle for a lump sum payment plus a period of “open medical care” to assist the injured worker to ease back into the work force. Again, all settlements are voluntary. No one can force you or the employer or the insurance company to agree to a settlement.
I have no hesitation in stating that you should not engage in settlement negotiations without having your own lawyer. Your employer and the insurance company will have lawyers on their side. Your lawyer can help you in many ways to deal with the wide variety of issues that can arise during negotiations. Even if the negotiations do not proceed to a settlement, your lawyer can find out what laws and facts are not disputed, so that the hearing can be limited to only the important issues of your claim.
Even very difficult cases can often be settled at a “mediation.” Mediations are conferences scheduled by the State Board of Workers’ Compensation once the employer and the insurer agree that they will negotiate in “good faith” to try and reach a settlement with the injured worker. It is good news when an insurance company and the employer agree to mediate a claim with an injured worker.
Sometimes, several months can pass before the employer/insurer is willing to negotiate a money settlement with an employee. Once an agreement is reached, however, the State Board must approve the settlement. The extra time required for the approval process at the State Board serves the employee very well. It ensures that your rights are fully protected.
Again, no one can force or order a settlement. If all parties (the worker, the employer and the insurance company), do not agree to settle some issue, then that issue must be decided after a formal hearing on the issue.
Attorney fees are governed by the Workers’ Compensation Act and each attorney fee contract must be approved by the State Board of Workers’ Compensation.
In Georgia, the employee’s lawyer is paid a contingency fee of 25%. That amount is clearly stated in my attorney’s fee contract. This means that the lawyer’s fee is directly proportional to the amount of money the lawyer “wins” or “settles” for the injured worker.
Under Georgia law, a lawyer must cap his fee at 25% of any monies the lawyer is able to obtain for the worker. Therefore, the injured worker retains 75% of the money his lawyer is able to procure for him, minus litigation expenses that the lawyer advanced to the injured worker to pursue the claim. For instance, if the injured worker and his lawyer had to go to a hearing to prove a claim and the judge ordered the insurance company to pay a sum of $30,000.00, the injured worker would receive $22,000.00 and his attorney would be paid $7,500.00.
This FAQ page is intended to help you understand a little bit about this very complicated area of Georgia law. If you need assistance with your workers’ compensation claim, you should hire a lawyer who thoroughly understands the Workers’ Compensation Act of Georgia. You can contact us for help in resolving your workers’ compensation claim.