You deserve the best workers’ compensation lawyer to fight for you, and here’s why…
A common question we get asked at the outset of a case is: Why should I hire an attorney?
Our answer is simple:
The insurance company has a small army of lawyers working full-time looking out for their company’s best interests. So why shouldn’t you, the injured worker, have someone on your side who understands the law, too?
Reasons why you shouldn’t trust your employer or their insurance company
One thing injured workers commonly say is that they think the insurance company and their employer are doing everything “by the book,” so they don’t need legal representation. However, we believe this common belief is troubling for 2 basic reasons:
1. Unless the injured worker practices in the workers’ compensation field, they likely don’t fully understand their rights under the law—and insurers know this. Just because the insurance company says they are doing what they have to do, is that really the case? How do you know this is true? Remember, who is framing the discussion: the insurance company.
2. Basic business principles dictate how insurance companies make money. They collect premiums and don’t pay out on claims. Recently, an insurance company executive said that premiums made on workers’ compensation insurance policies are a significant reason insurance companies are so profitable right now.
Ways a workers’ compensation attorney can protect an injured workers’ rights
The rules and regulations underlying workers’ compensation in Georgia are codified in O.C.G.A. 34-9. There are many different statutes within the code that instruct injured workers what they have to do (and when), and also place obligations on the insurance company. Without knowing what all of the requirements are, it is difficult (if not impossible) for the injured worker to ensure that they are availing themselves of all of their rights.
Furthermore, there are affirmative steps that the injured worker must undertake. By hiring a workers’ compensation attorney, you can make sure that your rights are preserved.
Filing within the deadline (statute of limitations)
The first (and maybe most important) of these regulations is the statute of limitations and how to preserve the right to file a workers’ compensation claim. The injured worker must report their injury within 30 days of the accident or their claim may be denied.
However, reporting the claim has many aspects. An employer can tell an injured worker that a claim was never officially reported and deny their claim. But there are many different ways to report a claim. An attorney can work with you to ensure that proper notice was given.
Depending on the scenario, an injured worker must follow many different timelines to determine if they have filed a notice of a claim in the appropriate amount of time. Most injured workers have 1 year from the date of injury to file their claim, or 1 year from the last payment of medical treatment by the workers’ compensation insurance carrier. In other cases, they may have 2 years subsequent to the last payment of indemnity benefits.
The exact deadline you must follow can be quite complicated. A practiced worker’s compensation lawyer will be able to tell you exactly how much time you have based on the details of your case.
Payment of medical expenses
An injured worker may not know who paid for a medical appointment. It could be covered by their personal health insurance or workers’ compensation. This is especially true if their health insurance is provided by the same employer whom they were working for when they were injured. Furthermore, an injured worker could be sent to a doctor by their employer after an on-the-job injury and absent-mindedly provide their personal health insurance card for payment.
An attorney can help sort this out and ensure that if you were sent to panel doctor, that workers’ compensation make the payment to that doctor. This will ensure that you pay no out-of-pocket expenses, and toll the statute.
Payment of lost wages
Payment of indemnity benefits is rarely cut and dry either. Wage loss benefits are defined as payment of monetary benefits to an injured worker when a covered injury occurs. This is important to the injured worker because it replaces lost income, and it also affects when a claim can be filed.
Sometimes the injured worker is out of work because of an on-the-job injury and the employer continues to pay them a check. This may actually be salary in lieu of compensation and under the law, may actually be considered indemnity benefits. This can have many implications beyond just tolling the statute of limitations. It also may entitle the injured worker to treat with an authorized treating physician at the expense of the insurance carrier.
It should enable the injured worker to enforce their rights under Georgia law (O.C.G.A. 34-9-202(e)) and have an independent medical examination with the doctor of their choosing at the expense of the insurance carrier.
Managing light duty restrictions & temporary disability benefits
If an individual who is hurt on the job and is on work restrictions is now earning less than they were prior to their injury, may be entitled to temporary partial disability benefits. An attorney can help you figure out why you are working less. They can also help the injured worker get paid for the difference in wages and help calculate these benefits.
Navigating disputes over impaired body parts
When an injured worker is hurt on the job and provided a rating by an authorized treating physician for that injury, they can be compensated for that rating. This is codified in O.C.G.A. 34-9-263 and is another form of indemnity benefits for the injured worker.
Many times, there are disagreements over both the facility where the functional capacity evaluation will take place (which the doctor will subsequently use in assigning the permanent partial disability rating) and the body part that is being rated.
The Georgia legislature has created a schedule of income benefits for each body part. That means that each body part is worth a certain number of weeks as a result of the disability. This is codified in O.C.G.A. 34-9-263(c). For example, the loss of a thumb is worth 60 weeks of indemnity benefits, while a middle finger is only worth 40 weeks. Another example is that an arm is worth 225 weeks, while the neck/back is worth 300 weeks.
A real life example of a disputed body part happened to a client of ours. The individual hurt themselves while lifting a product over their head while on the job. The insurance company accepted the case and paid for the injured worker to get medical treatment. The injured worker was diagnosed with a shoulder injury and treated.
However, an independent medical examination performed at the request of the injured worker demonstrated that there was a neck condition as well. The difference in the rating between these 2 body parts (shoulder and neck) was extremely significant, which resulted in our client receiving a rating that was 75 percent higher than what they would have received for just the shoulder.
Choosing a workers’ compensation doctor
Another way an attorney can assist an injured worker in is with the choice of doctors. The insurance company may try and force an injured worker to only treat with an industrial clinic. Many times, the injured worker will receive inadequate care at these facilities. Their concerns may not be appropriately documented and addressed. However, it may be cheaper for the insurance carrier to have the injured worker treat there alone.
However, the injured worker is not only entitled to a change in authorized treating physicians, but the attorney can work with you in choosing a doctor off the panel of physicians, or maybe even invalidating a panel.
The authorized treating physician is extremely important to your claim, and choosing the right one is a vital step. Having an attorney who has knowledge of the best doctors can be crucial in getting an injured worker the treatment they require and deserve.
Returning to work
Another area where an attorney can be of service is during the process of returning to work while you are still hurt. There is a process that the insurance company must follow to legally request an injured worker return. This involves providing a detailed list of available work activities, the physical requirements of those activities, and how long those activities are. The doctor is required to review the job and sign off on it. Then, the injured worker is supposed to be given 10 days’ notice. An attorney can make sure that the proper process is followed.
Lastly, settlements are another important area where attorneys can assist you. Attorneys know when it is advantageous for the injured worker to consider settlement, and when it is not. They can also work with injured workers to craft demands and discuss what a case is actually worth. Every case is unique, and so is each settlement. It’s important to work with a lawyer to fully understand your rights and maximize the potential of your workers’ compensation claim.
If you have any questions about why you may need an attorney, don’t hesitate to contact the experienced Atlanta work injury lawyers at Gerber & Holder Attorneys At Law.
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