GEORGIA WORKERS’ COMPENSATION LAW

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Frequently Asked Questions

Medical Care Issues

Can I go to my own doctor or do I get a choice of doctors?

Georgia employers are supposed to have a panel of six doctors posted and one of them must be an orthopedic surgeon. You select a doctor and he or she becomes the authorized treating physician and provides treatment at the employer’s expense. If you see your own doctor, without authorization from the employer or their insurance carrier, they usually do not have to pay for the treatment. In an emergency situation prior authorization generally will not be required.

If I don’t like the doctor I’m seeing, can I get a second opinion?

In Georgia, you have a right to an independent medical examination, to be paid for by the Employer/Insurer, but only one time and within 120 days of receiving any disability benefits. You may always seek a second opinion at your own expense, of course.

Why does it take so long to get procedures and appointments authorized?

This is probably the most frustrating aspect of the workers’ compensation system for the doctors and for the injured employee. In Georgia, once an authorized treating physician is selected, the insurance company is supposed to pay for all reasonable treatment, but the doctors generally want to get authorization from the adjuster before scheduling appointments, tests, therapy, surgery, and so forth so they can be assured that they will be paid. This often results in delay.

How do I get my prescriptions filled?

If you have the money, you can always pay for a prescription yourself, provided it is written by the authorized treating physician, and then seek reimbursement from the insurance company. Of course, you may not be able to afford to pay for your prescription and then wait on reimbursement. Frequently, the adjuster will authorize a pharmacy to fill your prescriptions, but only if written by your authorized treating physician. And, insurance companies often contract with other vendors to review and monitor the prescriptions being filled. If a request for a new or different prescription is submitted, sometimes there is a delay while the medical records are obtained and the reason for prescribing the medicine is reviewed.

What do I do if my employer won’t pay my medical bills that are incurred as a result of the on-the-job injury?

First, make sure that the bills have been properly submitted to the workers’ compensation insurance company. Insurance companies will not pay until they have documentation as to what the bill was for, that it was related to your work injury, and that it was either authorized or due to an emergency. Do not allow the employer or a medical provider to submit bills to your group health insurance provider. Most group plans (such as Blue Cross Blue Shield, for example) contain an exclusion for work related medical expenses. If the workers’ compensation carrier will not pay valid authorized or emergency medical expenses, we can file a motion with the Georgia State Board of Worker’s Compensation and try to get an order compelling payment.

How much do I get for mileage for medical treatment?

In Georgia cases, the employee is entitled to reimbursement for all travel to any authorized medical provider, including going to the pharmacy.

What happens to my medical care once I settle the case?

In Georgia, there is no law prohibiting settlement of future medical care, and generally insurance companies will not settle cases unless you agree to close future medical.

What is a Medicare Set-Aside or MSA account?

If you are eligible for Medicare benefits, or will become eligible for Medicare within 30 months, settlement of future medical care becomes much more complicated. Medicare does not want employers or workers compensation insurance companies to dump their obligations for future medical expenses onto the Federal government. So, if settlement of future medical care is proposed and you are eligible for Medicare, a certain amount of the settlement money must be “set-aside” in a separate account to be used only for those medical expenses that would otherwise be paid by the workers’ compensation insurer. The account is called a Medicare Set-Aside account and is commonly referred to as a MSA. Only after the MSA funds have been properly spent on medical care will Medicare assume any responsibility for payment of your work related medical expenses. The MSA is designed to protect your right to Medicare benefits, and to protect the employer and insurer from being sued by Medicare for not paying for your future medical care.

Disability Issues

How much will I be paid while I unable to work?

You are entitled to two-thirds of your average weekly wage, subject to a maximum limit of $575.00 per week for injuries occurring on or after July 1, 2016. For injuries occurring between July 1, 2013 and June 30, 2016, the maximum benefit is $525.00 per week. Before July 1, 2013, the maximum rate was $500.00 per week.

When does the insurance company have to send my check?

After an injury occurs, there is a one week waiting period before any disability benefits are due, so you get nothing for the first week off work. However, if the disability continues for at least 21 days, then the employer and their insurance carrier do have to make up and pay the first week’s benefits retroactively.

Where is my check?

This is the most frequently asked question we get! Insurance companies are notorious for not paying on time. Unfortunately, they can legally run about two weeks behind on payment. In a Georgia case, benefits are due 21 days after the employer has knowledge of the injury and benefits are to be paid weekly thereafter. The law provides for an automatic 15% penalty if disability benefits are not paid when due.

Return to Work Issues

Will I get my job back?

It depends. Of course, we hope that as a valuable employee with knowledge and skills, your employer will be anxious to have you back and will hold your job for you as long as possible. The workers’ compensation laws in Georgia do not require your employer to hold your job for you after an injury. However, your employer and their insurance company can frequently save money on the claim by putting you back to work when you are released by your doctor, which gives them some financial incentive to try to get you back to work. In Georgia, temporary benefits can continue for nearly eight years (400 weeks) if the employer does not put you back to work, so finding a job for you can save their insurance company a lot of money. And, the Federal Family & Medical Leave Act (FMLA) may apply in certain situations, and require the employer to restore you to your former position, or an equivalent position.

Can I still collect benefits if my doctor releases me to light duty?

If you are eligible for Medicare benefits, or will become eligible for Medicare within 30 months, settlement of future medical care becomes much more complicated. Medicare does not want employers or workers compensation insurance companies to dump their obligations for future medical expenses onto the Federal government. So, if settlement of future medical care is proposed and you are eligible for Medicare, a certain amount of the settlement money must be “set-aside” in a separate account to be used only for those medical expenses that would otherwise be paid by the workers’ compensation insurer. The account is called a Medicare Set-Aside account and is commonly referred to as a MSA. Only after the MSA funds have been properly spent on medical care will Medicare assume any responsibility for payment of your work related medical expenses. The MSA is designed to protect your right to Medicare benefits, and to protect the employer and insurer from being sued by Medicare for not paying for your future medical care.

How much will I be paid if I perform light duty?

That is up to the employer, and it may be less than what you were earning before the injury. But, you may be eligible for temporary partial disability benefits as described above.

What do I do if I am offered FMLA?

Fill out the papers and take it. Be sure the request for leave is for the same serious health condition as your injury.

General Questions

You can be fired at will in Georgia except for reasons prohibited under state or Federal law, such as race, color, sex, national origin, age or disability. An employer can almost always find a pretense for firing an employee, such as being late for work or for violating a safety rule, etc. However, there are financial incentives that usually discourage responsible employers from firing employees after an injury on the job, as discussed above.

Can I obtain unemployment benefits after being injured on-the-job?

Generally you cannot collect both unemployment benefits and disability benefits under workers’ compensation. You must be ready, willing and able to work to qualify for unemployment benefits. If there is a dispute over your injury on the job, or if the workers’ compensation benefits are delayed for some reason, and you are able to do light duty work, you can apply for unemployment benefits to help you get by, as long as you are careful to state on the application that you are willing to work within your restrictions.

Exclusive remedy – can I sue my employer for getting hurt on the job?

No. Workers’ compensation is a no-fault system that provides benefits regardless of who caused the injury. Accidents on the job happen for many reasons. Sometimes a co-worker is careless, sometimes the employer furnishes defective equipment or working conditions are unsafe, and sometimes the injured person makes a mistake. Even if the employee is careless, causes an accident and hurt himself, he or she still gets workers’ compensation benefits. The trade-off for such a system is to prohibit the employee from suing the employer for anything other than workers’ compensation benefits. If the injury was due to the fault of someone other than the employee, a co-worker or the employer, however, the employee may be able to bring a lawsuit against the negligent party for medical expenses, lost earnings and pain and suffering. For instance, if the employee is injured in a wreck out on the highway while on the job, he/she could collect workers’ compensation benefits and still sue the “at fault” driver for all his/her damages. See Construction & Industrial Accidents. And Georgia, the Employer/Insurer would have a lien or subrogation claim on the proceeds, but only to the extent of benefits paid and provided the employee is fully compensated which is a variation of the made whole rule.

Bisected by the Tennessee River, bordering Georgia and Alabama, at the junction of three interstate highways, including the heavily traveled I-75 corridor, Chattanooga, Tennessee is both a historic railroad town and a modern transportation hub.  I-24 begins in Chattanooga running northwest toward Nashville, TN.  I-59 also begins just outside Chattanooga and runs south toward Birmingham, AL.  To the south, toward Atlanta along I-75, lies Dalton, GA a world center for the carpet and flooring industry. Chattanooga’s diversified economy includes the Volkswagen North American assembly plant, as well as insurance giants Blue Cross Blue Shield and Unum.  Chattanooga is also a major tourist destination attracting millions of visitors each year.  As a result, The Hamilton Firm LLC focus much of its work on representation of persons injured in trucking and transportation related cases as well as serious workplace injury cases.

Chattanooga is the headquarters for two of the nation’s major trucking companies, U.S. Xpress and Covenant Transport. And as crossroads city, Chattanooga ranks first in the nation among all metropolitan cities for the volume of freight moving through the city by truck (according to a recent freight study by Cambridge Systematics and reported in the Chattanooga Times Free Press). Problem areas include the interchanges as well as the entire section of I-24 from I-59 to I-75, and I-75 north to Cleveland, TN. Tractor trailers, while essential to a thriving economy, also present great risks to the traveling public if not operated safely by well trained professional drivers with well maintained equipment.

Chattanooga is also a rail hub for Norfolk Southern and CSX railroads.  Travel, transport and commerce by water, rail and road are essential to our lives and economy, but all the economic activity also brings traffic and congestion, which can lead to more wrecks, accidents and injuries.  This can be a volatile mix when combined with the high freight volume on tractor trailers traveling through or originating in the area.