My firm often hears the same questions when discussing workers’ compensation claims with people. We have listed some of those questions below and given short, general answers to them in an effort to better explain the system. Keep in mind, the facts of each case, the circumstances of the injury, the relationship of the employee to the employer and many other factors may cause these basic questions to have different results than described in an individual case. If you have any questions about workers’ comp, if you have more specific questions than are addressed here or have facts that may cause the answers to vary in your particular case, please contact us for a more complete explanation concerning how your specific facts relate to the law in the state of Georgia.
1. What is workers’ compensation?
As you might guess, workers’ compensation is benefits (both financial and medical) paid to or on behalf of a worker injured while performing work for the employer.
2. How do I qualify for a workers’ compensation claim?
If you are classified as an employee and become injured within the course and scope of your employment for an employer that has 3 or more employees, you probably qualify. Please contact us for a more complete explanation.
3. What do I have to do to make or file a claim?
If you have been hurt on the job, you must report the injury within 30 days of its occurrence to be eligible for benefits, usually to your supervisor. It may be wise to send a certified letter to the employer immediately after the injury setting out the location, time and type of injury. If no action is taken by your employer or their insurance company, you must file a claim with the State Board of Workers’ Compensation within 1 year of the occurrence of the injury to preserve your claim. If you fail to do either of these two things, you may have waived your right to bring a claim. Please contact us for a more complete explanation.
4. What kind of benefits am I entitled to under a workers’ compensation claim?
In general, you are entitled to medical treatment for as long as your injury is a problem for you. (There are now some limitations.) If you are disabled by your injury, you may be eligible for various income benefits ranging from temporary total disability to temporary partial disability to permanent partial disability. Income benefits may be limited to a specific period of time and dollar amount depending on the facts of your case. There are other related benefits for which you may be entitled depending on your condition. The benefits you receive are not designed to completely compensate you for your losses. The Georgia workers’ comp system is only in place to prevent you from sinking too quickly so that you can return to the workforce. Please contact us for a more complete explanation.
5. When will I get my first income benefit check?
If you are disabled by your injury, you should receive an income benefit check by the end of the third week after becoming disabled. The law gives the employer and insurer a three week grace period before they are required to pay benefits. Please contact us for a more complete explanation.
6. How much will my income benefit check be?
The amount of your benefit check for total disability is two-thirds of the average of your gross weekly income for the 13 weeks prior to your injury up to the cap in place at the time of your injury. Unfortunately, the cap instituted by the state legislature in Georgia is the lowest in the country. If you are able to work but are earning less than you could before your injury, you may be entitled to temporary partial disability benefits of two-thirds of the difference between what you made before your injury and what you make afterwards. That amount is also capped by the state legislature. Please contact us for a more complete explanation.
7. How long will my income benefits be paid?
For temporary total disability benefits, you will usually be paid as long as the authorized treating physician keeps you disabled. These benefits are capped at 400 weeks. If you have returned to work and are being paid temporary partial disability, you are eligible for these benefits for up to 350 weeks from the date of injury. Benefits beyond 400 weeks are only attainable if your claim is either accepted or declared catastrophic. Many factors go into whether a claim is considered catastrophic. Please contact us for a more complete explanation.
8. How do I pick a doctor and get treatment?
All employers in Georgia are required to have a list or posted panel of at least 6 doctors from whom you may receive treatment. The list should be in a place accessible by the employees (usually a bulletin board in a break room or common area). YOU HAVE THE ABSOLUTE RIGHT TO PICK A DOCTOR FROM THE PANEL. Your employer cannot tell you that you must treat with a particular doctor. If there is no panel posted, you may pick you own doctor with whom you wish to treat, and your employer and their insurer should have no input in that decision. Please contact us for a more complete explanation.
9. Do I ever get to choose my own doctor?
If your employer fails to follow the rules and post a panel, you may be entitled to pick your own doctor. Also, if you are receiving income benefits or recently did receive income benefits, and you are concerned about your treatment, you may be able to choose a doctor to evaluate your condition at the expense of your employer or its insurer. Please contact us for a more complete explanation.
10. Can I be reimbursed for mileage and prescriptions?
Where a claim has been accepted as valid, you are entitled to be reimbursed $.40 per mile for all mileage that you incur that is related to your medical treatment – to/from the doctor, therapy, hospitals, testing sites, the pharmacy, etc. Please contact us for a more complete explanation.
11. Who pays my medical bills?
The employer and its insurer are responsible for all authorized medical bills related to your accepted injury. You are not required to pay any portion of the medical bills. Problems often arise over what treatment is authorized. Please contact us for a more complete explanation.
12. What should I do if I receive a medical bill for treatment that was authorized?
All bills must be sent to the insurer for payment. You may do that yourself or have your attorney do it for you. Please contact us for a more complete explanation.
13. If I already have a doctor, do I have to see another doctor chosen by the company?
Yes. The Employer or their insurance company has the right to send you to a doctor of their choosing as long as you claim the right to benefits. This is known as an Independent Medical Examination (IME), although they are usually not independent at all. The Employer or Insurer send you to an IME for a reason – either to attempt to send you back to work and to cut off your benefits or to affect your treatment in some way. Please contact us for a more complete explanation.
14. Can I receive benefits if my job aggravates a preexisting, unrelated medical condition?
If the aggravation is temporary, it is still compensable until it resolves. If the aggravation is permanent, you may have a new injury. Please contact us for a more complete explanation.
15. If I have another non-work related injury while receiving benefits, can that affect my workers’ comp benefits?
Yes. No compensation will be paid where a subsequent disability breaks the chain of causation between the work related injury and the non-work related injury. Please contact us for a more complete explanation.
16. How can my income benefits be stopped?
If the authorized treating physician releases you to work without restrictions, your benefits can be terminated. There are many other possible circumstances under which benefits may also be terminated. Please contact us for a more complete explanation.
17. Can I apply for Social Security if I am injured on the job, and can I received both Social Security benefits and workers’ comp benefits at the same time?
Yes, you can apply for and receive Social Security benefits and workers’ comp benefits at the same time. However, one or the other may take some kind of off-set or credit for the benefits paid by the other. It is usually to your benefit to receive the maximum benefit workers’ comp will pay and have Social Security take any off-set. However, many factors can go into the decision about whether you should apply for Social Security while on workers’ comp. Please contact us for a more complete explanation.
18. Do I pay income tax on my workers’ comp benefits or settlement?
No, workers’ comp benefits and workers’ comp settlements are generally not taxed as they are not considered income for tax purposes. Of course, changes to the law could occur at any time. Please contact us for a more complete explanation.
19. Can I be fired while disabled with an injury?
Yes. Georgia is known as an “at will” state. That means you are employed at the will of your employer. Your employer can fire you for any reason or no reason, as long as it is not an illegal reason. The state General Assembly does not protect an injured employee’s job while that employee is out disabled from an injury. Please contact us for a more complete explanation.
20. How much is my case worth and when will it settle?
There are far too many factors that can go into the value of a case for anyone to give you anything other than an extremely vague answer to these questions. To even attempt to list the factors that could affect your settlement would be an exercise in futility. Please contact us for a more complete explanation.
21. Should I get an attorney to help me with my case?
The fact that you’re seeing our website while seeking information about workers’ comp is certainly an indication that you or your family member or your friend may need legal assistance with the claim. My rule of thumb is that, if you have an injury that has or will likely disable you for a significant period of time, you should seek help.
The workers’ compensation system in Georgia is complicated and filled with traps for the unsuspecting. Attorney Tom Monk has assisted hundreds, if not thousands, of injured people with their claims. Our goal is to help you receive every benefit the law allows and to settle your claim for the right amount. We seek justice for our clients – justice for the injured. Please contact us for a more complete explanation and to determine whether we can help you “Tip the Scales” in your favor.