Georgia law used to provide that injured workers are entitled to medical benefits indefinitely, but legislatures have amended those rules. Medical care is currently capped at 400 weeks. However, if your injury occurred on or before June 30, 2013, or if your injury is catastrophic in nature, you may be entitled to lifetime medical benefits.

What types of income benefits does workers’ compensation provide?

Workers’ compensation also provides qualified injured workers with a weekly wage replacement check until they are able to return to work, until they have reached maximum medical improvement, or until they have reached the 400-week maximum allowable benefit period. In most cases, your income benefits will be two-thirds of your pre-injury average weekly wages, and are subject to a cap of $550/week. Income benefits do not totally replace your pre-injury income, but they are certainly a godsend when trying to make ends meet.

There are three general types of income benefits injured workers may be entitled to:

  • When you cannot work at all: If your injuries are such that you cannot work, you can qualify for Total Temporary Disability (TTD) benefits. You will receive two-thirds of your weekly wages for up to 400 weeks or until the doctor okays you to go back to work. If your injuries are catastrophic in nature, you are not subject to the 400-week cap on benefits.
  • When you are on light duty: If you can work in some degree, but have to work less hours, are only able to perform light-duty work, or otherwise have to take a lesser paying job because of your disability, you can still receive partial wage replacement. The Georgia State Board of Workers’ Compensation (SBWC) will calculate these payments at two-thirds of the difference between your pre- and post-injury wages.
  • When you have lost the use of a body part: If you have permanently lost the use of a body part, you can qualify to receive Permanent Partial Disability (PPD) benefits. The amount and duration of benefits depends on your degree of disability (as determined by your doctor), the specific body part that was hurt, and your wages. O.C.G.A. § 34-9-263 details the PPD payments schedule.

What are the eligibility requirements for benefits?

Workers’ compensation eligibility is pretty straightforward. Fault/negligence do not come into play, nor does your tax bracket or tenure. The following stipulations are essentially all you need to meet the requirements:

  • Your injury must have occurred in the scope and course of your work or your illness must have resulted from work conditions, i.e., your condition is work-related.
  • You must be an employee. (Independent contractors do not qualify.)
  • You must not have caused your own injuries, and you must not have been intoxicated or involved in horseplay when it occurred.
  • You must adhere to all the rules and requirements provided by Georgia workers’ compensation laws.

What are some reasons my employer’s insurer may have denied my claim?

The requirements may be straightforward, but insurers deny or prematurely shut off many workers’ claims for numerous reasons each year. For instance, the employer/insurer may claim that the injury was pre-existing or not work-related or that you are fabricating or exaggerating your injuries.

In the Workers’ Compensation Handbook, the SBWC reports that some of the most common ways employees can jeopardize their benefits include:

  • Failing to promptly report injuries
  • Failing to cooperate with the authorized treating physician or the employer
  • Not returning to work when suitable work is available
  • Falsifying information
  • Refusing to take a drug test
  • Refusing to submit to a medical exam

What do I do if the insurer has denied or challenged my claim?

If the insurer denies your claim, you will receive a notification in the mail containing a general description of the reason for denial. If the insurer denied your claim and you disagree with the decision, you have the right to appeal the denial. To do so, you will need to file a claim with the SBWC within one year of the date of injury. You must use Form WC-14, Notice of Claim to inform the Board.

If you still do not receive benefits, you can request a hearing with an Administrative Law Judge (ALJ) who will decide if you are entitled to receive benefits and if so, what benefits you may receive.

A workers’ compensation attorney from the Law Office of Jason R. Schultz, P.C. can help you file your appeal, gather evidence to bolster your case, and represent you at the hearing with the ALJ.

For questions about workers’ compensation in Georgia or for help securing your benefits, contact Jason today and request a free consultation: 404-474-0804.

Jason R. Schultz
Helping Georgia area residents with car accident, medical malpractice, and personal injury claims since 1991.