Your Atlanta | Savannah Work Injury – What You Need To Know
Their are many different phases of a Georgia workers’ compensation claim. We have attempted in this blog post to break them down so you know questions you should be concerned with and what is most important to you the injured worker. This is not completely inclusive but it will give you a good understanding of the workers’ compensation system and how to protect yourself.
The phases we have broken down are as follows:
Phase 1 – The Injury.
Phase 2 – Reporting the Injury.
Phase 3 – First medical visit.
Phase 4 – Work status.
Phase 5 – Income benefits.
Phase 6 – Medical benefits.
Phase 7 – Hearings.
Phase 8 – Settlement.
Employment – Workers’ compensation is constructed to protect employees. There are several questions about if someone is an employee and/or if they maybe a contractor. Generally speaking workers’ compensation does not provide coverage to someone who is a contractor and works for themselves.
Employee versus Independent Contractor
There are several things to look at in determining if you are a contractor versus an employee. Some of the things you look at is method and manner of work. Does your employer/boss pay you per job or by the hour, do you use your own tools or are the tools provided for you, if you additional work was added to the job would you be paid more, are taxes taken out of your pay, are you told what time to show up for work and when to stop, are you allowed to work for other people while you are working for the current employer. These are not hard and fast rules, they do help draw a picture of the amount of control an employer or general contractor has over your work and will help the court determine if you are deemed an employee or a contractor.
Excluded from the the Workers’ Compensation system…there are some employers who are exempted from the system. Any employer who does not maintain three or more employees would not be required to maintain workers’ compensation insurance coverage. The employer can, he is just not required too by Georgia law. Equally important there are other jobs that are excluded from the workers’ compensation system such as agriculture
workers. It is always important to speak with a Georgia workers’ compensation attorney if you are concerned your employer may not have workers’ compensation insurance coverage.
You can always contact the Georgia State Board of Workers’ Compensation coverage unit and provide your employer’s information to find out if there is workers’ compensation insurance coverage.
Phase 1 – The Injury.
In this post it is important to understand that for this post, we will presume you have injured yourself while in the course and scope of your employment, meaning doing what you were hired to do by your employer. You did not want to hurt yourself, but now you find yourself injured, either unable to work or just not sure what to do. There are various levels of injury.
Hurt/injured and don’t know it and transported to the hospital or morgue; hurt/injured and know it and transported by ambulance; hurt/injured and know it and not transported by ambulance; hurt/injured, but not sure how serious it is and just hope the pain will go away.
• Hurt/injured and don’t know it and transported to the hospital or morgue.
These injuries are serious and severe, the injured worker is either unconscious or unresponsive due to the serious nature of the injury. This may include loss of life or limb and is a very serious injury which is typically a big work accident. OSHA should be called immediately to investigate.
• Hurt/injured and know it and transported by ambulance.
These injuries are also serious/urgent enough to require someone to call an ambulance to have medical personnel come to where they are injured to provide urgent medical care.
• Hurt/injured and not transported by ambulance.
These injuries are typically simple injuries which do not require emergency medical care. Examples of these type of injuries would be where you hurt your back but can still walk and move your arms and legs.
• Hurt/injured but not sure how serious it is and just hope it will go away.
These are most injuries where you lift something and feel a pop and some pain but you are hoping it is something that will heal on its own. You do not feel it is worth mentioning because you feel/hope it is minor and will not require extensive treatment.
Phase 2 – Reporting the Injury - a Critical Step
One of the most important things you can do is report your injury and request medical care for your work injury. For the injured workers who hopes the pain goes away, not providing notice to your supervisor will keep you from getting medical care. You can not hide this from your employer and have a workers’ compensation claim. The notice provision under Georgia law requires that you notify your employer immediately. If it can be proven that your employer was not provided notice within thirty days, you will likely be denied any medical care or income benefits as it relates to your injury and then you will be required to pay for your injury out of pocket while you can not work with no income.
Who do you report your injury too? It is suggested that you report this to your supervisor, if your supervisor is not available, report it to your supervisor’s supervisor. It is critical that you tell them you got hurt, what you were doing when you got hurt and that you need medical care for your injuries. If you do not inform your supervisor that you need medical care, they will likely presume you are alright and not think anything of it.
What if my supervisor will not send me for medical care? – If your supervisor will not file a injury report and help you get medical care you should contact the supervisor’s boss and or the owner and let them know, if they do not do anything then you may need an attorney to help.
My boss says it will affect everyone’s Christmas bonus, how do I handle? - If you are hurt and require surgery, you may never see a bonus or even work at the same place. If your injury is really minor, then you may want to reconsider, however if you are in pain and unable to work, you will not get a bonus anyway and may not be employed there much longer if you can not physically do the job. You have to decide what is more important, your ability to work and provide for your family or the bonus the supervisor and other workers may get.
What if my employer terminates me if I report the injury? Unfortunately, this is common. If the employer terminates you because of your work injury, you are still entitled to medical benefits and possibly income benefits, you will want to reach out to a Georgia workers’ compensation attorney immediately. What is important is that you do not quit. If you quit out of frustration, you will lose your right to income benefits. While this will not prevent you from obtaining medical care, you will have what is called a medical only claim. The insurance company and the employer both know you will typically have a hard time getting a lawyer to help you if you have a medical only claim.
What is the most important thing I should due when reporting my injury? The most important thing you can do when you report your work or on-the-job injury/injuries is to make sure you report ALL body parts injured. If any are missed you can count on the fact that the insurance adjuster will deny any treatment for any injuries which were not initially reported at the time of your injury. This is critical and we have seen many cases where the insurance company and their attorneys fight very aggressively against paying for injuries which were not initially listed even though they may have been present.
Phase 3 – First visit with a doctor.
How do I get to a doctor? You should speak with your supervisor/boss/owner and request medical care. Georgia law requires that they maintain what is known as a posted panel of physicians. It is another word for a list of doctors you can seek medical care from if you are hurt on the job. There are many legal requirements which will make the panel valid. If a panel is invalid or not legally proper, the injured worker may be able to go to any doctor (who accepts Georgia workers’ compensation) he/she wants.
Why is it taking so long, I am in pain, is there something I can do? The insurance adjuster is able to control the medical care if the employer maintains a legally valid, properly posted panel of physicians. Even if the employer does not maintain a properly posted panel of physicians, the doctors you treat with will want prior authorization for any appointments. This is so the doctor knows they will be paid for their services. Unfortunately, this can take longer than most injured people in pain want to wait. That said, you must be diligent to obtain any referrals or paper work to help the adjuster. This in turn will help you obtain your appointments quicker. If you are in a great deal of pain and an appointment has not been scheduled it is recommended that you go to the emergency room. However, keep in mind repeated visits to the emergency room may be denied by the insurance company.
What is a posted panel of physicians? As stated above it is a list of doctors you can see if you are injured on the job. It should be posted in a conspicuous place, often this is posted in the break room or where the federal wage and hour documents are posted.
Who do I chose, does it matter? Choosing the right doctor does matter even if you have to choose your doctor from a posted panel of physicians. Different doctors have different reputations. While that should not matter, the truth is, there are some doctors that know they will be paid by the insurance company and will bend over backwards to do what the insurance company asks such as return an injured worker to work earlier than the injured worker expects or maybe even physically ready for.
If your injury is a back injury, you typically want to see an orthopaedic spine specialist or neurologist versus a general practitioner.
Can I just go to my own doctor? Typically speaking, no. However you maybe able to go to your doctor if there is no posted panel of physicians and your doctor accepts workers compensations, it just depends upon the facts of your particular case. It is suggested you speak with a Georgia workers’ compensation attorney and provide them the specific information on your injury so they can tell you if this is possible for your claim.
What is the most important thing I should do when I get to the doctor? Just like when reporting all injuries, you want to notify the doctor of all injuries from head to toe. If you forget and the doctor does not document all of your injuries you may have the insurance company denying medical care for those body parts. It is better to mention it too many times than not to mention it at all.
Phase 4 – Work Status
After every medical visit you should obtain a sheet of paper known as your work status report. This will provide you and your employer with information on if you can work, and what you can and more importantly can not do. There are three types of work statuses: No work; Full duty work; Light/limited/modified/sedentary duty work.
No work – This means the doctor has taken you out of work completely and that you can not return until you go back to the doctor for another work status report. The length of time maybe for a day, two days or until you are able to obtain further testing, that is up to the doctor.
Full duty work This means the doctor is releasing you back to full duty work with no restrictions or limits. This typically happens when the doctor feels that you have recovered from your injuries.
Light/limited/modified/sedentary duty work This means your doctor does not believe you can go back to full duty work, but believes you are able to do some type of work. Typically the doctor will explain the restrictions, like no bending, stooping, squating, no use of right or left arm, sitting/standing as needed, no more than 2 hours a day, etc.
Note you should provide the work status reports to your employer. If you have light/limited/modified/sedentary work status, your employer may either have a position for you to return work or may create a position for you to work. This is a very critical point in your claim. It is recommended that you speak with a Savannah | Atlanta workers’ compensation lawyer immediately to understand what your options are and what requirements your employer may have. For questions with your workers’ compensation claim feel free to contact our office at 912-508-4711 in Savannah or 770-948-5454 in Atlanta or toll free 866-937-5454.
Phase 5 – Income benefits
Income benefits - There are three forms of income benefits, temporary total disability, temporary partial disability and permanent partial disability benefits. You can only receive one at one time.
Temporary Total Disability Benefits also known as TTD Benefits- If you are taken out of work completely for more than seven days you are entitled to temporary total disability benefits. These benefits are for injured workers who are totally disabled for a temporary time frame.
Temporary Partial Disability Benefits also known as TPD Benefits- If you have been placed on light duty and have returned to work but are working less hours you may be entitled to these benefits. These benefits are for injured workers who are partially disabled (they can do some work)for a temporary time frame.
Permanent Partial Disability Benefits also known as PPD Benefits- At some point an injured work will recover from his/her injuries. That said, they may not be back to 100% as they were prior to their work injury. If that is the case, their doctor will likely issue what is known as a permanent partial disability rating. This rating is taken based upon the injured workers’ condition and the doctor declaring them at maximum medical improvement. Maximum medical improvement is where the doctor does not think there is anything they can medically do to improve the injured workers’ condition or injury. At the time the injured worker is at maximum medical improvement, the doctor will based upon the patient’s condition go to the American Medical Association Guidelines 5th Edition and will determine what the injured worker’s permanent partial disability percentage rating is and will issue a rating.
How do you get temporary total disability benefits started? You are not entitled to these benefits until you are taken out of work for seven days. Once you have been or will be taken out of work for more than seven days your insurance adjuster will need to authorize and set up weekly payments.
How are temporary total disability benefits calculated? Your weekly temporary total disability benefits are calculated by taking 13 weeks of prior gross pay. You average the 13 weeks of pay to come up with what is known as your average weekly wage. Once you have your average weekly wage, you take either 2/3rd’s of the average weekly wage or 67% of the number. That is what is known as you “comp rate”. Please note the comp rate maximums change often and it is based upon the date of injury as to what rates apply. For example as of 2016 the maximum comp rate is $550.00 per week. This means as of 2016, no one in the workers’ compensation system that is being paid workers’ compensation benefits is paid more than $550.00 per week. Please also note every state is different and has different maximum comp rates.
If you could have a claim in multiple states you will want to speak with attorneys in both states to see what benefits maybe best for you and your family.
How are temporary partial disability benefits calculated? This is a more complicated calculation, as it is typically when a worker has been returned to work but is working less time and is not earning what that employee’s “comp rate” is. Therefore the calculation is 2/3rds of the difference between the average weekly wage before the injury and the average weekly wage after being returned to work. There are also caps on this amount. However because of the fluctuation of weekly pay can alter this number weekly. For specific questions on your temporary partial disability benefits, you should reach out to a Savannah |Atlanta workers’ compensation attorney.
How are permanent partial disability benefits calculated? Permanent partial disability benefits are paid when the injured worker is no longer entitled to temporary total or temporary partial disability benefits. The calculation is best explained on the back of the WC-2.
How long do you get temporary total disability benefits? Once you receive weekly temporary total disability benefit checks, you should receive them until there is a change in condition for the better, meaning a doctor releases you to light duty and/or full duty.
Is there anyway to increase the temporary total disability benefits? If these benefits are miscalculated you there is a chance you could be entitled to more. If you have questions regarding the calculation of your income benefits you should reach out to a Savannah | Atlanta workers’ compensation attorney, the consultation is free and you can get your questions answered to see if you are being compensated properly for your work injury.
Is there anyway to increase the permanent partial disability benefits? It is possible your injury could create a greater disability, certainly this is not anything to look forward too. The increase is typically very small.
Are taxes taken out of the weekly checks? No, taxes are removed from workers’ compensation payments. If there is a settlement, workers compensation is typically not treated as a taxable event.
When do the checks stop, is there any type of warning? Typically you will be released back to work by your doctor and that will provide you the notice that your checks will be stopping. You should then receive a WC-2 in the mail stating the exact date your income benefits will stop.
Phase 6 – Medical benefits
Does the nurse from the insurance company have to come into my appointments? No, you can ask the nurse not to attend the appointments with you.
Why is the nurse speaking to my doctors? If the insurance company hires a nurse you can expect they are going to go talk to the doctor and his staff about your case. Unbelievably this is allowed in workers’ compensation. Don’t think for one second the nurse is not working to get you released back to work, or to have the doctor reconsider a surgical recommendation or reconsider if the cause could have been naturally occurring versus traumatically induced or that the injury was going to occur regardless of if you got injured at work. This is quite frankly a downfall of the system. We have medicine that is influenced by the very people who pay the doctor’s office. If the nurse does not show up, they call and call until they get an answer.
Is the nurse talking to my doctors when I am not there? Without a doubt, see “Why is the nurse speaking to my doctor?”.
What about HIPPA am I protected? While the fight continues currently you waive your HIPPA rights when you file a workers’ compensation claim. Which means, the insurance company can and will speak with your doctors and often will the medical records quickly. The system seems to have the doctors’ offices working hand and hand with the insurance companies. While this is certainly not always the case, it is alot of the time. To add insult to injury, we have recently seen when either our office or the employee requests their records from a doctor’s office, the doctor’s office will say we are giving it to the insurance company you can get it from them. The system has is problem points.
My doctor sent me for an MRI/EMG/Nerve Conduction Study/Physical Therapy or any diagnostic test? If you have been ordered any type of test or physical therapy it is critical to minimize delay that you request a copy of the MRI script from the doctor or his staff, otherwise you will likely be waiting for the adjuster to receive the request from the doctor’ s office. You never really know if they are waiting on it or if they have it. It seems odd that they can get full duty releases in less than a day, but a script for an MRI or other diagnostic test can sometimes take weeks or even months. Be diligent.
My doctor recommends surgery why is it taking so long? Just like anything else the adjuster will want to see the script and the doctor’s note requesting surgery and will then need to authorize and approve that workers’ compensation will pay for it. This does not happen overnight so you will want to do what you can to provide the proper paperwork to the adjuster.
What if I do not want surgery? This is a very personal decision, one that should not be made quickly. Unfortunately, I have had many clients who did not want surgery only to physically breakdown to the point that the pain was so bad they needed the surgery to get pain relief and not lose addition functions like the ability to walk. When your condition breaks down this far it becomes medically necessary to have the surgery. Everyone is different just know if you tell your surgeon I do not want this surgery, they will write that in their medical records and the adjuster will see and know you do not want the surgery. What transpires next is typically the doctor will release you from care at maximum medical improvement since you do not wish to undergo surgery. Then the adjuster will be doing everything they can to resolve the claim or cut your checks. If you agree to attempt to settle your claim, the adjuster will not pay you for a surgery you need, because you have refused it. If you want the surgery paid for, we have seen the adjuster say then get the surgery done, we will not give you money for a surgery you have told your doctors you do not want. Take note and govern yourself accordingly.
The adjuster schedule me an appointment with another doctor, do I have to go? If the insurance company or adjuster schedule you an independent medical evaluation (IME) they are choosing a doctor to see you for a one time visit. The adjuster does this when they are not happy with the opinion your current doctor also typically known as you authorized treating physician. Why would they do that you ask? Well if you have a doctor saying you need surgery and they do not want to pay for it, they will hire a doctor to say you do not need surgery. These are both medical opinions and if you are in the workers’ compensation system long enough you will notice there are very different medical opinions. That said this is a strategic move to obtain evidence that supports the insurance/employer’s side of their claim.
What if I do not go to the independent medical evaluation? If you are receiving weekly checks and choose to not go to the independent medical evaluation, the employer/insurer can motion the Administrative Law Judge to suspend or stop your income benefits until such time as you comply with their request. It is advisable you attend all schedule medical appointments unless your attorney tells you otherwise.
Do I have to give the adjuster my past medical records? Why? Yes, by submitting a workers’ compensation claim you have arguably given up your rights to privacy provided by HIPPA. That said, your past medical condition may be the reason you have a work injury and so they are able to argue the past records are important to their claim and typically speaking most Judges will agree.
What is a WC-207? A WC-207 is the form the Georgia State Board of Workers’ Compensation has provided to obtain medical records.
Phase 7 – Hearings
The workers’ compensation system is an administrative based system. That means you do not file a lawsuit in Municipal, State or Superior court. You file a hearing with the State Board of Workers’ Compensation. Also, you file a hearing to seek benefits you feel you are entitled too. You can not file a hearing for your case to settle.
Do I need an attorney for a hearing?
What is the benefit of an attorney?
What can I expect at the hearing?
What happens prior to the hearing?
What is a WC14?
What is discovery?
What are Interrogatories?
What are Request for Production of Documents?
What are Request for Admissions?
What is a deposition?
Do I have to speak with the attorney for the insurance company?
Phase 8 – Settlements
Settlement is completely optional in workers’ compensation. As such, with little to not experience you may miss your window of opportunity to settle your claim, so be careful. When seeking a settlement, realize workers’ compensation will put value on pain and suffering like a personal injury claim.
What does workers’ compensation look at when they consider settlement?
When is the best time to settle your workers’ compensation claim?
What is a mediation?
What is a mediation notice?
What should I expect at a mediation?
What happens if my case does not settle at the mediation?
Can’t come to the office due to your injuries? We can come to you. Give us a call today in Savannah 912-508-4711 or Atlanta 770-948-5454.
You have the power to change your future. Take it.