How to use these terms when filing a workers’ compensation claim in Georgia
If you have experienced an on-the-job injury or illness, you may be considering a workers’ compensation claim. In Georgia, workers’ compensation insurance is administered through the State Board of Workers’ Compensation (SBWC) and paid for by employers.
Any employer in Georgia with 3 or more seasonal, part-time or full time employees must carry workers’ compensation insurance for its employees. If the company is incorporated or an LLC, it must carry workers’ compensation insurance even if it has only 1 employee. Government agencies, farm laborers and railroad companies don’t have the same workers’ compensation insurance requirements. The Georgia SBWC provides a listing of all covered businesses.
Before you file any claim, it’s in your best interest to become familiar with some workers’ compensation definitions. Words are sometimes thrown around and the injured worker is expected to know what they mean, even if you have never heard of them before. But it is important to understand their meaning.
Let’s look at some of the most common terms you’re likely to encounter while submitting your work injury form or filing a claim. By no means is this an exhaustive list; they are merely phrases and words that we find to be most commonly used in the workers’ compensation arena.
Workers’ compensation glossary of terms
- Attorney For Employee/Claimant and Attorney For Employer/Insurer. Many workers benefit from hiring an attorney to represent them during a workers’ compensation claim. Not only may an attorney be of assistance if the employer or insurer refuses to pay, but they also determine if justice should be pursued beyond the workers’ compensation process. Of course, the employer and insurer may also have legal representation.
- Board Claim Number. After you file a claim with the SBWC, it will issue you a 9-digit case file or claim number.
- Catastrophic. Workers’ compensation benefits are limited in Georgia to 400 weeks of payment. The exception to this rule is if an injury is deemed “catastrophic.” A catastrophic injury in Georgia is defined as any one of the following injuries:
- Second or third degree burns over 25% of the body, or third degree burns to 5% or more of the hands or face
- Any other injury that prevents the employee from being able to perform their prior work in substantial numbers within the national economy for which they are otherwise qualified.
- Dependency Benefits. In Georgia, if a work-related death occurs, the workers’ compensation law provides benefits to the dependents of the deceased worker.
- First Date Disabled. In Georgia, the date of disability is the first day the employee is unable to work a full day.
- Indemnity benefits. This is the term commonly used for wage replacement or “lost income” benefits. There are 2 main types of indemnity benefits: temporary total disability (TTD) benefits and temporary partial disability (TPD) benefits. An injured worker is eligible for this benefit if the authorized treating physician takes them out of work for more than 7 consecutive days, if the authorized treating physician has placed them on work restrictions which their employer cannot meet, or if they are on work restrictions and their employer cannot offer them the same amount of hours or the pay rate decreases with the new job so they earn less than they received while working. In Georgia, the maximum amount of weekly indemnity benefits changes yearly and there is no cost of living increase over time.
- Insurer/Self-Insurer. Georgia employers purchase workers’ compensation insurance in the private market from an insurance carrier or agency that is licensed to write that type of policy in the state. Alternatively, if an employer meets certain specifications, it can petition the SBWC to be self-insured. The SBWC and the Georgia Self-Insurers Guaranty Trust Fund evaluate each applying employer to determine if it qualifies for self-insurance. The SBWC then issues a 5-digit ID number to each employer.
- Jurisdiction. Jurisdiction is the venue in which the case can be brought. This is important because workers’ compensation laws are specific to each state. For example, in some states, indemnity benefits can be stopped when an individual reaches maximum medical improvement (MMI). However, this is not the case in Georgia so it is important to bring a claim in a jurisdiction that most benefits the injured worker.
There is jurisdiction in Georgia if either of the following 2 conditions are met:
- The accident took place in the state of Georgia.
- The contract of employment was made in Georgia and the individual resides in Georgia, or the employer is in Georgia and the contract for employment wasn’t for work exclusively outside of Georgia.
- Light Duty Work Restrictions. These are restrictions placed on an injured worker by the authorized treating physician. They specifically relate to the individual’s injured body part and place restrictions on the work they can perform. It is important to provide the work restrictions that the authorized treating physician places on you to your attorney immediately. Just because an employer may not have an existing job within these restrictions doesn’t mean that they will not create a special one for an injured worker.
- Maximum medical improvement. When the authorized treating physician determines that an injured worker has healed as much as they are going to, they have reached maximum medical improvement (or MMI). This doesn’t necessarily mean that the injured worker is fully healed. It merely means that the authorized treating physician believes they have plateaued and will not get better. In some states, this means that indemnity benefits can be suspended, but not in Georgia. When an individual reaches MMI, they are entitled to a permanent partial impairment (see PPD below) rating on top of whatever indemnity benefits they are eligible to continue to receive.
- Medical Benefits. Georgia workers’ compensation laws require payment for all necessary and reasonable medical treatment that is related to a work injury or illness.
- Notice Of Claim Only. Your first filing of the WC-14 can be notice of claim only.
- Permanent Partial Impairment Rating. This means a disability which is partial in character but permanent in quality, resulting in the loss of a portion of functionality of a body part. The state legislature of Georgia has established a formula to compensate injured workers for the loss of this functionality. The formula is the workers’ compensation rate multiplied by the impairment rating multiplied by the body part. Each body part has been assigned a value by the legislature, ranging from 300 weeks to the body as a whole, all the way to 20 weeks for loss of any toes (besides the big toe).
- PPD. PPD stands for permanent partial disability.
- Request for Catastrophic Designation. Many work injuries or illnesses are short-term and, following recovery, the employee can return to full employment. However, sometimes an employee may suffer a catastrophic injury or illness that results in a loss of function or permanent disability. Georgia law provides for specific benefits if a catastrophic designation is granted under a workers’ compensation claim.
- Request For Mediation/Notice Of Claim. The third choice at the top of the WC-14 form is a request for mediation. A mediator is a neutral person who works with the parties to help reach a resolution in the dispute. The mediator may offer suggestions and assistance, but does not make a decision. The parties have to agree on the final decision. Mediation in workers’ compensation cases is voluntary.
- Request Hearing/Notice Of Claim. If your benefits are denied, you can request a hearing by checking this box at the top of the WC-14 form. The hearing takes place in front of a workers’ compensation judge. The judge requests information from both parties. You can present your case and medical records to the judge, present other witnesses to support your case, and be cross-examined by the lawyer representing your employer or their insurance company. The insurance lawyer may also present paperwork and witnesses. The judge will not release a decision at this time. Both parties draft closing briefs, which summarize their positions, and present them to the judge.
- TPD. TPD stands for temporary partial disability.
- TTD. TTD stands for temporary total disability.
- WC-14 Notice Of Claim. This is the form that is administered by the State that you can obtain from the SBWC, find online and complete. It is 1 page. To file a claim, you need to complete Form WC-14, file it with the State Board of Workers’ Compensation, send a copy to your employer and send another copy to your employer’s workers’ compensation insurance carrier.
There are many other forms and phrases associated with workers’ compensation claims in Georgia. This list of workers’ compensation terminology is associated with words commonly found on the WC-14 form. Before filing a claim, become familiar with the process and terms associated with workers’ compensation claims.
If you need assistance with filing your compensation claim, the skilled team at Gerber Holder Attorneys At Law is experienced and trusted by injured workers throughout Georgia.