Workers' Compensation Frequently Asked Questions (FAQs)

The following are answers to many questions that we are asked about workers' compensation, and will help reiterate some of the concepts we have covered as well:

1.) What Is Workers' Compensation?

As soon as you begin working your employer is responsible to provide you with workers' compensation in the event that you are injured on the job, or a loved one dies on the job, whether that injury or death is due to an accident, or an injury or death that is due to the duties of your job in your place of employment also known as an "occupational injury." The law is meant to protect both the employee and the employer if such unfortunate events happen on the job.

The employee is protected by the law by receiving monetary compensation to cover expenses that the employee may not be able to pay as a result of not being able to work. Workers' compensation also includes medical benefits to make sure that injuries and illness are treated as soon as possible and in the best way. This will help to return the employee to the same physical, mental and emotional place where the employee was prior to being injured on the job, if possible.

The employer, in turn, accepts liability for any accident in the workplace and is, therefore, protected from being sued by the employee. As such, the workers' compensation law works for both the employee's and employer's benefit.

2.) What Does Workers' Compensation Encompass?

In other words, who does the workers' compensation law protect? The workers' compensation law protects employers and employees. This may seem like an obvious statement but, under the law, who is defined as an employer and who is defined as an employee can be somewhat unclear. Georgia defines employers whether they be corporations, individuals, firms, associations or the like and states that employers must provide workers' compensation insurance for all of their employees if they have three (3) or more people working for them on a regular basis. Likewise, contractors must provide workers' compensation coverage to subcontractors if the subcontractor does not have their own workers' compensation insurance.

Georgia law defines employees as anyone who works on a regular basis whether it be full time or part time. The definition includes corporate officers, minors and limited liability company members. It does not include, however, partners or sole proprietors that are not employed by the business.

Although employers, as defined herein above, are responsible for providing workers' compensation insurance or be self-insured, not all employers have this coverage. This does not absolve the employer from liability, and the employer who does not provide proper insurance can also be at risk of facing penalties by the State Board of Workers' Compensation. If you are wondering whether or not your employer has workers' compensation insurance, you can look to see if there is a Notice of Compliance and the State Board of Workers' Compensation Bill of Rights posted in the manager's office, break room or some other obvious place, then you will know that your employer has the proper workers' compensation insurance.

It is important to note, however, that just because the employer has the proper workers' compensation insurance does not mean that the insurance company is going to look out for your best interests if you are injured on the job. To the contrary, it is the business of the insurance company for you to receive as little compensation as possible if you are injured, or if a loved one has died on the job, to save the insurance company money. It is, therefore, important to seek legal counsel if you are injured on the job, or a loved one is killed on the job, so that you receive the most amount of compensation instead of the least amount of compensation.

3.) What Does No-Fault Workers' Compensation Mean?

This means exactly what it says and that is that the employee does not have to prove that the injury or death was the result of any negligence of the employer. This takes a tremendous amount of burden off of the employee. Therefore, regardless of how the accident happened or who caused the accident to happen, as long as the accident took place on the job while you were on the clock working, then you are eligible for worker's compensation protection. Workers' Compensation cases are still complicated, but the no-fault portion of the law makes it easier for you to focus on getting well instead of gathering evidence to prove your claim.

4.) How Does Medical Care Work Under Workers' Compensation Law?

Unfortunately, you are not able to go to your own doctor after a workplace injury and you must go to a doctor that the employer chooses depending upon three (3) different options that the employer prefers. The three (3) options are as follows:

a.) Option One: This option provides for a traditional panel of physicians that consists of six (6) physicians, including one (1) orthopedic physician, and two (2) or less physicians from industrial clinics.

b.) Option Two: This option provides for a conformed panel of physicians that consist of the same physicians as the traditional panel of physicians in option one and then includes at least four (4) other physicians, and it also includes a chiropractor and a general surgeon.

c.) Option Three: This option is the most complicated and it involves your employer working with a Workers' Compensation Managed Care Organization that is certified by the State Board of Workers' Compensation and the medical care is delivered by your employer and the organization, and it must also include minority providers.

Whether your employer has option one, two, or three, this information must be posted in a obvious location so it can be referenced when necessary. Choosing which doctor is the best doctor to work with can be a daunting task for the injured employee. We are experienced in this area of law and, therefore, know the reputation of many doctors that are available through all of these options so we are able to assist you in choosing the right physician for your particular circumstances.

5.) What Does It mean To Win A Workers' Compensation Claim?

A workers' compensation claim might seem straightforward at this point such as your employer automatically accepts responsibility, you pick a physician for treatment, and your treatment is paid for, and then you get treatment so you can get back to work. Unfortunately, it is not this straightforward and if it was, then there would be no need to have experienced legal counsel on your side. The reason it is not this straightforward is because the insurance company, who is in the business of saving money and spending the least amount possible on your claim, is always trying to find ways to pay the minimal amount possible to you as an injured worker. They do this by trying to find ways in which you are making mistakes in your claim and, if you make mistakes in your claim, then you do not win your workers' compensation case and your financial future is at stake. Therefore, there are some very important steps to follow to make sure that you win your workers' compensation claim, and this is what it means to win your workers' compensation claim:

a.) A winning settlement means not having to pay out of pocket for any part of the accident that happens on the job. These expenses include, but are not limited to, medical expenses, treatment expenses, or any other bills that you incur as a result of your injury on the job. Therefore, it is imperative that you follow all of your doctor's instructions, and let your doctor know of any and all additional symptoms you have experienced after being hurt on the job. This is very important so that your doctor can have you on the best treatment plan for your condition and so that you get well and fully recover. It is important to communicate any new symptoms and get the proper treatment before your claim settles since once your claim settles, then you may not be able to recover for any additional injuries even if they were caused from your injury on the job.

b.) A winning settlement means getting the full compensation you are entitled to after your workplace injury. You are entitled to compensation for injuries on the job, or if a loved one was killed on the job. Remember, just because the employer has workers' compensation insurance does not mean that the insurance company will automatically pay you what you are entitled to as compensation of your injuries on the job. To the contrary, as we have stated many times before, the insurance company is out to pay you as little amount as possible for your on the job injury. Therefore, winning your case means that you have to aggressively fight the insurance companies and this requires a complete understanding of the law. An experienced workers' compensation attorney has a complete understanding of the law that you need in order to get the full compensation that you are entitled to in your case.

c.) A winning settlement means receiving compensation that will keep you and your family financially secure after a serious on the job injury. If you are not fully healed when your case is over, then you may not be able to work the same job that you did before and provide for your family as you did in the past. In fact, many on the job injuries result in permanent disabilities. Therefore, your long term financial security must be taken into consideration when negotiating a settlement for your workers' compensation claim. With the support of documentation from your medical doctor, you should be able to receive disability benefits to compensate you for not being able to do work that you once did. Therefore, a winning case means that you are covered at the current time and that you are also covered in the future.

6.) What Damages Are Available To Me As An Injured Employee In A Workers' Compensation Settlement?

There are three (3) main types of damages that may be available to you under your workers' compensation claim in Georgia:

a.) Medical Costs. Medical costs include treatment costs such as surgery and any pre and post-surgery medical expenses. Medical costs also include rehabilitation costs, and your employer must also allow you time away from work for your rehabilitation program. Finally, medical costs include a return to work program that allows you to return to work in a capacity that you are able to handle after your injury and this might include limited or light duty. You may not be able to return to the job that you did before you were injured and it is the responsibility of your employer to work with you to allow you to return to work in a manner that takes into consideration your injury and condition. To make sure that this happens, you must follow your doctor's orders and recommendations, and your employer must do the same as well. If you or your employer deviate from what your doctor has recommended, then you run the risk of having part of your claim denied for medical expenses and/or disability benefits.

b.) Disability. As discussed above, there are different types of disability and you are entitled to compensation for these types of disabilities such as temporary disability benefits, permanent partial disability benefits and permanent total disability benefits.

c.) Death. In the very unfortunate situation where an injury on the job causes the death of a loved one, then the family is entitled to workers' compensation and this can include the costs of the burial and the income that they once relied upon for support from the deceased.

7.) What Are The Critical First Steps That I Should Follow After An Accident On The Job?

a.) Notify your employer as soon as possible. Technically, you have 30 days to notify your employer of your injury on the job. Some injuries are obvious and serious enough that you may notify your employer right away. Some injures, however, may not present themselves with symptoms right away and you might not know that you have actually been injured. Therefore, if you even think that you have suffered an injury on the job it is imperative that you tell your employer right away. This is important for a couple of reasons. First, it will hopefully prevent someone else from being injured. Second, it puts your employer on notice that you have a workers' compensation claim. Once you have notified your employer, your employer must file a workers' compensation claim with their insurance company and the process will start of having your costs covered and you can begin to get well again.

b.) Seek medical attention right away. This is very important and critical to your claim. You might not feel as injured as you really are and any delay in treatment could hinder your ability to get well again. As stated above, the doctor that treats you must be one of the approved doctors that your employer has chosen and you should be able to find this information wherever the other workers' compensation information is posted. Furthermore, seeing a doctor right away is critical for your workers' compensation claim. If you delay treatment, then the insurance company may use this as a reason to pay less for your claim and remember, the insurance company will do whatever they can to pay as little as possible for your claim.

c.) When you file a claim, it is imperative that you have an experienced workers' compensation attorney on your side to represent your interests so that you receive the most amount of compensation that you deserve. We encourage you to contact us, Julie A. Rice, Attorney at Law, & Affiliates, at 770-865-8654, 800-419-0860, by email at [email protected], or on our contact page on our website. You do not want to fall victim to the insurance companies and our workers' compensation lawyers started as attorneys working for the insurance companies so we know the strategies that the insurance companies will try to devalue your claim. The following are the top seven (7) reasons it is imperative that you have a skilled workers' compensation attorney on your side:

i.) To Assist you in Finding the Best Doctor for Your Care for your Injuries. As stated previously, our attorneys know the doctors and are skilled at finding the right physician for your injury and claim.

ii.) To Help you Learn and Understand your Legal Rights. Workers' Compensation claims are complicated and if you do not know and understand your legal rights you could jeopardize your claim and your future. Don't leave it up to the insurance company or your employer to do the right thing in this situation. You need to take responsibility for knowing your rights and having a strong advocate in your corner is key.

iii.) To Take the Burden of Dealing with Insurance Companies off of You so You can Focus on Getting Well and Getting the Most Amount of Compensation that you Deserve. The attorney that you hire will deal with the insurance companies for you and protect you from making mistakes in your claim. The insurance company will not be able to play games with you and your claim if you have an attorney handling your case. It is your attorney's job to deal with the insurance companies so you can focus on getting well, and so that you receive the most amount of compensation that you deserve.

iv.) Get An Experienced Opinion of What Your Claim is Worth. We know how to value your claim and this is not an easy job. With the right attorney, you do not have to worry that your medical bills won't be paid, that you won't receive the proper treatment, or that your financial future will be in jeopardy.

v.) Get Invaluable Peace of Mind that your Claim is being Handled in the Best Possible Way. You won't lose sleep at night worrying about your claim with the right attorney by your side protecting your interests.

vi.) Find Added Sources of Income that you may not have Realized were Available to you. You do not want to run the risk of missing a bill or leaving money on the table for the insurance company. You want to be protected from paying anything out of pocket, and increase your chances of winning your claim.

vii.) Have Confidence in Knowing that your Final Settlement will Cover Your Costs and Keep Your Family Protected. If you are not able to work, then you and your family can suffer terrible financial hardship. You want to be confident and know that your final settlement will cover the costs of your injury and protect the future of your family.

8.) The Following Is A List Of The Most Common Questions That People Have About Their Workers' Compensation Claim:

Q: Can I sue my employer for my injuries?
A: In most cases, the only way that you will receive compensation for your injury on the job is by filing a workers' compensation claim. There are some instances, however, where a lawsuit may be in order such as if a third party caused the injury or your employer negligently hired the third party. It is imperative that you receive legal advice in order to determine if a lawsuit is necessary, or possible, in your case.

Q: Is there any reason that my employer may refuse to pay my workers' compensation?
A: Even though workers' compensation insurance is meant to protect both the employer (from costs and liability) and the employee (assuring that the bills are paid for the injury and so forth as described herein), some employers will refuse to pay a claim. If this happens, then your case should be brought before an administration law judge. As you can imagine, this is very complicated and it can take months for your case to be heard. When you have an attorney on your side, you have assistance with this process and it is also less likely that your employer will refuse to pay your claim without just legal cause.

Q: Can I do anything to help my claim move faster or get a larger settlement?
A: Yes, you can work closely with your attorney and keep your attorney up to date on any details that are pertinent to your case. You can also make sure that any calls are directed to your attorney so you are not bothered with calls, or so you don't say the wrong thing, and your attorney can work to move your claim along more quickly.

9.) What Should I Expect During The Negotiation Of My Claim?

a.) The first thing that you should expect is an investigation of your claim. The insurance company has 21 days to investigate your claim and determine if you are entitled to benefits. Most insurance companies complete the investigation on time. Others, however, do not and may take as long as six (6) months to evaluate your claim in which case you are left without income and compensation for a long time. This is not as likely to happen if you have legal counsel on your side.

b.) You should also expect to continue to receive medical care from your approved doctor. Again, it is critical that you follow your doctor's orders, attend all appointments, do any and all rehabilitation that is ordered by your doctor, and follow all of your doctors instructions precisely. This is not only critical to your claim, but it is critical to your recovery.

c.) You should expect to receive income through your benefits, or by performing light duty at work. If you are not able to work, then your doctor will put you on a "no work" status and you will not work until your doctor determines you can work. During this time, you should receive benefits from the insurance company so you have income. If, however, you are able to work light or limited duty, then you may work, but only if your employer allows you to work. If you employer does not allow you to work, then the insurance company will pay you benefits during this time. Finally, if you were on a "no work" status and then your doctor tells you that you can return to work on a limited status, do not return to work until you have consulted with your attorney.

d.) You should also expect frequent updates from your workers' compensation attorney. This is a two way street. It is important that you notify your attorney of any changes in your condition, any calls from the insurance company, or any changes relevant to your claim. Your attorney should also update you with any status they have on your claim so you know that your claim is being moved along for you.