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Injured Worker Rights – Know Your Options
If you are injured at work and the insurer accepts the claim as “compensable” you will need to pick a doctor from the Panel of Physicians that the employer is supposed to have posted in a conspicuous location as well as take reasonable steps to understand what it means.
A Panel of Physicians is a list of at least 6 doctors that your employer must have posted in a conspicuous location. Your employer must also explain to you the purpose of the Panel of Physicians. The panel must include at least six (6) physicians or professional associations. It must also include at least one orthopedic surgeon, a minority physician and four other properly qualified physicians. The Panel can have no more than two (2) industrial clinics.
If your employer has a valid, posted Panel of Physician and it is explained to you, you will need to select a doctor from the Panel. If your employer does not have a Panel or does not explain it to you, you may be able to treat with a doctor of your choice.
Unfortunately no, there is no compensation for pain and suffering in workers’ compensation. The amount of benefits are set by statute and very few cases are “million dollar” cases. You would have to suffer a severe, catastrophic injury for that type of settlement…you don’t want that type of injury!
NO! If this happens, contact your attorney but do not immediately quit. The insurance company will use this as evidence that you are unwilling to work.
Please do not do this. This will greatly complicate your claim and may preclude settlement of your case down the road.
Injured workers have rights and responsibilities pursuant to O.C.G.A 34-9-81.8. You may receive medical, rehabilitation income benefits. The goal of these benefits is to help you get better and return to work. This is a general overview of your rights under the Act. In a separate page, I describe PPD ratings and what they mean.
“Compensable” claims entitle you to reasonable and necessary treatment to cure or relieve the effects of the work injury. This is a frequent area of litigation. However, reasonable and necessary is subject to interpretation and debate. Sometimes you can’t work because of your injury. You need the Authorized Treating Physician to provide you with a work excuse. The excuse must state “totally disabled.” If you are off work as a result of your work injury you may be entitled to weekly monetary benefits called weekly income benefits.
You are only entitled to TTD income benefits if you are off work for more than seven consecutive days, deemed compensable or “accepted” by the insurance company, and certified disabled by the Authorized Treating Physician. Unfortunately, you will not be paid for the first seven days that you are off work. Missing work for more than 21 consecutive days due to the injury results in retroactively payment for seven days.
You may be able to, however, the insurance company is entitled to take a “credit” for the amount of the unemployment benefits paid during the same period.
This is a very complicated area but, in short, you should give your best effort to try the job. If you are receiving weekly indemnity payments and the employer offers you a light duty job, certain requirements must be met. Further, if you do not attempt the job or do not complete 8 hours of the light duty job or one workday (whichever is longer), your benefits may be suspended. If you refuse to even attempt it the insurance company the insurance company will use this as evidence that you are being unreasonable and do not want to return to work. For more information on this, see the section “Your Work Status.”
When you are injured at work, your employer/insurer can either choose to accept the claim as “compensable” or they can deny or “controvert” it. They may choose to pay medical benefits only and then refuse to pay weekly income benefits. They may also choose to controvert or deny the claim completely. If you are not receiving medical treatment or income benefits, you need to contact an attorney.
If there are issues in dispute between the injured worker and the insurance company, what generally happens is the injured worker’s attorney files a form called a WC-14 Request for Hearing form. This places the matter “on the calendar.” In other words, you get a date for your hearing, which is a court proceeding before the Administrative Law Judge. That is also the point when formal discovery takes place and the insurance company will likely depose you. Once they depose you they will want to get medical records from your doctors and likely talk to witnesses. This takes some time. Unfortunately because it takes time to get all the information together, hearings frequently get “continued” to new dates. It may take several months to actually have the hearing. In lieu of proceeding to a hearing, the parties will frequently try to informally resolve the matter, or the entire case.
Unfortunately this is not uncommon. Georgia is an “at will” state and, without an employment contract, a worker can be terminated “at will” as long as the reason is not discriminatory.
If your employer posted a Panel of Physicians (a list of at least six doctors) you must choose a doctor from that list. You may change to another doctor without permission from your employer from the Panel. If you are suffering from a medical emergency, you’re eligible for temporary medical care from any doctor until the emergency is over.
TTD – Temporary Total Disability
Temporary total disability payments or TTD income benefits come into play if you are taken off work completely by the Authorized Treating Physician. This is calculated by taking two thirds of your average weekly wage (of the wages for the 13 weeks prior to the date of accident) up to the statutory maximum. For injuries prior to July 1, 2013 the maximum is $500 per week. For injuries after July 1, 2013, the maximum $550 per week. This is nontaxable.
TPD – Temporary Partial Disability
Sometimes, the Authorized Treating Physician does not believe you are totally disabled. Instead, they believe you can perform a lighter duty job or work fewer hours, and you return to work at a lower paying job. As a result, temporary partial disability payments or TPD benefits are a possibility. Calculating these benefits can be somewhat tricky. It is very important that you keep track of all of your pay stubs and any post-injury wages earned.
There are time limits on how long you are eligible to receive income benefits. Specifically, there is a limit of 400 weeks from the date of accident for TTD benefits. It is 350 weeks from the date of accident for TPD benefits. In the past there was no time limit on the weeks you could receive medical treatment. However, injuries occurring after July 1, 2013 have a limit or “cap” on medical benefits beyond 400 weeks from the date of the accident. This does not apply to catastrophic claims. The majority of the claims in Georgia are not catastrophic.
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