7 commonly misunderstood workers’ compensation facts that every Georgia worker should know
Getting hurt on the job never comes at an opportune time. Injured workers rarely get the chance to prepare for the incident that causes the injury, and few are fully aware of their rights prior to an injury. Once you get hurt, there’s no guarantee that your employer will follow the important steps that they are required to do.
Furthermore, even if your employer properly reports the accident, their insurance company may still deny you benefits that you are entitled to under Georgia’s workers’ compensation statute.
In this article, we will list 7 facts about workers compensation that every injured worker in Georgia should know.
What is workers’ compensation?
Before we address these 7 facts that every injured worker in Georgia should know, let’s first review the basic principles of workers’ compensation in Georgia. Workers’ compensation insurance is required of businesses with 3 or more employees as established by O.C.G.A.34-9-1.
Workers’ compensation insurance covers individuals who are hurt in the scope and course of their employment. It provides 3 main benefits:
1. Medical treatment and care
First, it provides the injured worker with medical care. The injured worker will not have to pay any out of pocket medical expenses for this medical treatment. This means there are no deductibles or copays — all medical expenses are covered. Included in medical treatment are testing, such as X-rays and MRIs, and prescriptions ordered by the authorized treating physician.
2. Indemnity and lost wages
The second type of benefit provided by workers compensation insurance is indemnity (wage loss) benefits. Indemnity benefits are payments made to the injured worker in lieu of their salary. These benefits include temporary total disability (TTD) benefits, which are available if the authorized treating physician who is providing medical care for the injured worker either places the injured worker totally out of work for 7 consecutive days or provides work restrictions to the injured worker which the employer cannot accommodate. Total disability benefits are calculated by adding up the average pre-tax wage of the injured worker for the 13 weeks prior to their injury.
Temporary partial disability (TPD) benefits may also be owed. The injured worker becomes eligible for these benefits if they are placed on restrictions by the authorized treating physician and the employer can accommodate their restrictions, but the injured worker is earning less than they were before their injury.
3. Permanent partial disability rating
The third benefit an injured worker is entitled to in Georgia is a permanent partial disability (PPD) rating. This rating is determined by the authorized treating physician once the injured worker has reached maximum medical improvement.
Maximum medical improvement is a technical term that essentially means the doctor believes the injured worker has recovered as much as they are going to after their injury. At this point, the authorized treating physician states that the injured worker has a permanent disability as a result of the injury and assigns a percentage rating to that body part.
7 important workers’ compensation facts for injured workers in Georgia
Now that we have established what benefits an injured worker is entitled to, here are 7 facts regarding the workers’ compensation system in Georgia that every injured should know:
1. You cannot get compensated for pain and suffering in a workers’ compensation case.
O.C.G.A. 34-9-11 states that the exclusive remedy through their employer that an individual has if they are hurt on the job is through the workers’ compensation system. However, this doesn’t prevent an injured worker from bringing a liability claim against a third party if they caused the injury.
For example, if an employee was injured in a motor vehicle accident while on the job and a third party was at fault (another speeding driver, for instance), then they can sue that third party and receive benefits under the workers’ compensation system.
However, even if the employer was at fault for an injured workers’ injury, the worker cannot sue them in personal injury tort and therefore cannot receive compensation for pain and suffering.
2. You are allowed to choose a doctor to treat for your on-the-job injury.
Generally, your choice of doctor is limited to a panel of physicians. However, if there is no panel of physicians, or the panel doesn’t comply with the regulations established by Georgia law (O.C.G.A. 34-9-200), then you are entitled to treat with any doctor you want.
Additionally, if you don’t like the doctor who is treating you, you can make a one-time switch in authorized treating physicians to another doctor on the panel. Additionally, you can petition the State Board of Workers’ Compensation to request a change to a doctor of your choice.
3. You can receive payment for travel to all authorized doctor’s appointments, physical therapy, testing and to the pharmacy to pick up prescriptions.
This payment is set at $0.42 per mile and all mileage reimbursement requests must be submitted to the insurance company within 1 year of the date of service. The insurance company must make the payment to you within a certain amount of time to remain compliant.
4. If you are receiving indemnity benefits from the workers’ compensation company or being paid salary in lieu of workers’ compensation by your employer, then you are entitled to an independent medical examination with a doctor of your choice which is to be paid for by the insurance company.
This is a one-time right. If that doctor requests testing which hasn’t already been performed, then the insurance company has to pay for that as well.
5. Having a pre-existing condition doesn’t prevent you from receiving workers’ compensation benefits for that same body part.
If you reinjure a knee, shoulder or other body part while working for an employer, you can receive treatment and indemnity benefits for that body part. In fact, you can receive treatment on that body part until the doctor is able to return you to the baseline condition you were at before the injury. In some instances, this might not be possible, which entitles you to potentially lifetime benefits.
6. Failing a post injury drug test doesn’t mean you are not eligible to receive benefits under the workers’ compensation statute.
This is an affirmative defense and the employer has to meet certain standards to even put the drug test into evidence, such as the chain of custody of the drug test. Furthermore, the test must be taken within 8 hours of the accident. There is also a defense to a positive test if the proximate cause of the injury was not due to intoxication.
7. Filing a workers’ compensation claim doesn’t mean you will be terminated by your employer. But if you are terminated, there are some legal ramifications for the employer in the workers’ compensation arena.
Georgia is an at will employment state. This means that an employer can fire an employee for any reason so long as the termination isn’t in violation of federal discriminatory practices. However, if the employer fires the employee either for filing a claim while they are on restrictions, or before the authorized treating physician places them on restrictions, the injured worker may be entitled to indemnity benefits even if they are only placed on light duty restrictions. The reason is that the employer cannot accommodate those light duty restrictions because the injured worker is not an employee.
We hope these 7 facts about Georgia workers’ compensation help you better understand your rights in the event of a work-related injury. This list is far from exhaustive. If you have any questions about the information shared above or any other questions about workers’ compensation, don’t hesitate to contact the Atlanta attorneys at Gerber & Holder Law.