Answers to 12 common questions about Georgia workers’ comp benefits, laws and more
So you’ve been hurt on the job. The last thing you want to think about right now is the technicalities of your state’s workers’ compensation law. While you should talk to an experienced lawyer as soon as possible, it benefits you to understand your basic rights when it comes to workers’ compensation in Georgia.
Below are some of the most common questions about workers’ compensation law.
While these may provide a guide for you, there may be many complicating factors with your claim. Contact a lawyer at the downtown Atlanta, Georgia law firm of Gerber & Holder for your free consultation.
Georgia Workers’ Comp FAQs
What is workers’ compensation?
Workers’ compensation is a type of insurance that provides financial benefits for medical expenses, lost wages, and rehabilitation costs to employees who are injured or become ill in the course and scope of their employment. It also pays death benefits to families of employees who are killed on the job.
The workers’ compensation system was developed to provide speedy payment of income benefits and medical bills without the necessity of proving fault on behalf of the employer, co-workers or third-parties. Usually the employer purchases a workers’ compensation insurance policy that will pay these benefits.
To learn more, see our Guide to Workers’ Comp Benefits.
Am I covered under Georgia’s workers’ compensation law?
In general, if your employer has three or more employees and you were injured performing a task that arose out of, and in the course of your employment, you will be covered under workers’ compensation law in Georgia.
Do I really need an attorney?
Enforcing your workers’ compensation rights at times can be a challenging situation. Complicated forms and procedures must be followed. It’s often wise to have an attorney to represent you because of the many factors needed to win your case. Our decades of experience has taught us how to help secure the maximum amount of benefits for our clients.
Was your workers’ comp denied? Find out why your claim may have been denied.
The insurer wants to settle my case and to set up a Medicare Set-Aside account. What is that?
A Medicare Set-Aside account (or MSA) is used when you’re eligible or it appears you will be eligible for Medicare as a result of receiving Social Security Disability Income benefits. Medicare isn’t supposed to pay for treatment that you have received as a result of your injury. The amount of the MSA is an estimate of how much your future medical treatment that Medicare would otherwise pay would cost.
After settlement, you must place the money for the MSA into a separate account to be used only for payment of medical treatment and related expenses arising from your work injury. Your failure to properly use this money and account for it can result in a denial of Medicare benefits for other non work-related medical treatment.
I haven’t returned to work but my weekly benefit checks have been reduced. Can they do that?
It depends. If your doctor has released you to light-duty work and if the insurer complies with the many technical requirements of the law, your benefits can be reduced from temporary total to temporary partial, but only a year later. We would need to see all of the paperwork to give you an accurate answer.
Do I have to remain in Georgia in order to get workers’ compensation benefits in my claim?
No. You can continue to receive your weekly benefits no matter where you live. In addition, the insurer must provide you a doctor convenient to your new residence.
I am receiving the maximum amount of Georgia workers’ compensation benefits in my case. Am I eligible to have my benefits increased if the maximum benefit limits increases under the law?
No. You are locked into the maximum amount of weekly benefits in effect on the date of your accident.
Can I be fired for making a workers’ compensation claim?
Unfortunately, yes. Georgia is an employment at-will state, meaning unless you have an employment contract or are the victim of discrimination, you can be fired for any reason. The Georgia legislature rejected a bill preventing such firing for making a claim many years ago.
Your termination can be significant, however. If you are on regular duty work with no restrictions and you’re fired, then you will not be entitled to further temporary total benefits unless a doctor later said that you had some restrictions or that you couldn’t work. On the other hand, if you have some restrictions when you are fired, you may be entitled to workers’ compensation benefits.
If you were fired for reasons related to your workers’ compensation claim, your temporary total benefits should start immediately and you need not seek employment.
If it’s not apparent that you were fired for making the claim, you will probably need to look for work and prove that the reason that you couldn’t find work was on account of your workers’ compensation claim and the lingering effects of your injury. If you can prove this, then you would be entitled to temporary total benefits.
While you have no claim under Georgia law for being terminated, you may have rights under the federal Americans with Disabilities Act or other federal laws.
Am I personally responsible for my medical bills?
Not if you have an accepted claim and if you have seen the authorized treating physician. Georgia law prohibits the medical provider from billing you for such services.
When can the insurance company stop my benefits?
That’s a complicated question. There are limits to how long you can receive benefits. Without regard to these time limits, there are essentially three situations in which the insurer can stop your temporary total benefits without going to the State Board of Workers’ Compensation for permission. (There are many other situations in which the State Board can suspend benefits.)
- If the authorized treating physician returns you to work on regular duty with no restrictions.
- If you return to work making the same amount of money as you were making when you were hurt.
- If the insurer follows the procedure set forth under O.C.G.A § 34-9-240 and Board Rule 240 concerning offering you light-duty work and you don’t try to do it.
I am applying for Social Security Disability benefits. If I get them, will they be reduced because I am receiving Georgia workers’ compensation benefits?
Perhaps. The total of your workers’ compensation benefits and your Social Security Disability benefits cannot exceed 80 percent of your average monthly or current earnings. Usually, when your workers’ compensation case is settled, the documentation of the settlement agreement can be drawn so as to recoup a large portion of this lost offset.
I think someone from the insurance company is watching me. Can they do this?
Yes. It’s legal for an insurance company to perform surveillance. The insurance company in your case is likely trying to see if your restrictions are less than what you and your doctor say. Avoid doing any strenuous activity outside. The insurer will try to make it look like there’s nothing wrong with you. While you may be able to bend over and pick something up once, this doesn’t mean that you can do it all day. They may make a videotape that may be very misleading. Be smart and protect your rights in your case.
Visit the Georgia State Board of Workers’ Compensation for more frequently asked questions.
Our record of winning workers’ comp cases in Georgia speaks for itself:
Get Answers By Talking to an Atlanta Workers’ Comp Attorney
Are you ready to learn more about your injury claim? Fill out a contact form or give us a call and we’ll be in touch with you shortly to get more details about your case. The Georgia statute of limitations requires injured workers to file a workers’ compensation claim within 1 year from date of injury (not 2 years like most other personal injury claims). After this period, your chance to receive financial reimbursement may expire.