Georgia Workers’ Compensation FAQs
Do I have to prove who is at fault in my workers’ compensation claim?
No. Georgia workers’ compensation law is a “no-fault” system. A “no fault” system means, with a few exceptions for defenses available to the insurance company, injured workers in Georgia can file a claim for workers’ compensation benefits regardless of the injured worker’s contribution to the cause of the accident and injury. However, in exchange for the right to receive “no-fault” workers’ compensation benefits, injured workers do not have the right to sue the employer and do not receive any compensation for pain and suffering.
What defenses can the employer and insurer use to try and deny my workers’ compensation claim?
In Georgia, the insurance company has several “affirmative defenses” which they can use to try and deny you benefits. These affirmative defenses are:
- Willful misconduct
- Violation of a safety rule
- Failure to follow a duty required by statute.
- Intoxication by drugs or alcohol.
If the insurance company is trying to deny your claim with one of these affirmative defenses, you may want to discuss your case with an attorney to review your options.
How do I find out if my employer has workers’ compensation insurance?
The Georgia State Board of Workers’ Compensation has a website which anyone can use to check to determine if an employer has workers’ compensation insurance and to identify the employer’s workers’ compensation insurance company. It is located here:
https://sbwc.georgia.gov/online-employers-workers-compensation-coverage-verification
Which employers are required to have workers’ compensation insurance?
Under Georgia law, and with some limited exceptions, all employers with three or more regular employees/workers are required to have workers’ compensation insurance. Employees are individuals who work part-time or full-time and includes minors or any other person, regardless of status in the United States, who is working under contract of hire, written or implied.
How much do I get paid if I miss time from work for my workers’ compensation claim?
The amount of workers’ compensation income benefits you receive every week depends on your average weekly wage. Your average weekly wage is calculated by adding up your gross (pre-tax) wages for the 13 weeks preceding your accident and dividing by 13. Your workers’ compensation rate is only 2/3 of your average weekly wage. For example, if your average weekly wage in the 13 weeks before your accident is $600.00, your workers’ compensation rate is $400.00.
How long do I have to be out of work to receive workers’ compensation income benefits?
In Georgia, income benefits are owed to workers who miss seven or more days of work due to a work-related injury. If your injury causes you to miss 21 consecutive days, you are entitled to receive pay for the first seven missed days of work.
How long will the insurance company pay me workers’ compensation income benefits?
In Georgia, there are three types of workers’ compensation income benefits:
- Temporary total disability (TTD) benefits;
- Temporary partial disability (TPD) benefits;
- Permanent partial disability (PPD) benefits.
Temporary total disability (TTD) benefits are paid to you either when your doctor says you cannot work or when your doctor says you can work light duty but your job does not have light duty work available for you. Georgia law limits the maximum weekly amount of TTD benefits you can receive up to $675.00 per week for injuries from July 1, 2019 to the present.
Temporary partial disability (TPD) benefits are paid to you if you are working a light duty job but you are earning less than your pre-accident average weekly wage because you are either being paid less for your light duty work or your employer cannot provide you with as many light duty work hours. TPD benefits are 2/3 of the difference between your current weekly earnings and your pre-accident average weekly wage. For example, if your average weekly wage is $600.00 and you are earning $300.00 per week while working light duty, you are owed $200.00 per week in TPD benefits. This is based on the following calculation $600.00 – $300.00 = $300.00 x (2/3) = $200. Georgia law limits the maximum weekly amount of TPD benefits you can receive to $450.00 per week for injuries from July 1, 2019 to the present.
Permanent partial disability (PPD) benefits are paid to compensate you for your physical injury. While TTD and TPD pay you for the loss of your wages caused by your injury, PPD benefits are intended to compensate you for your actual injury. Georgia law has a schedule which lists out of the number of weeks of benefits you can receive for injuries to certain body parts. The number of weeks you are entitled to is based on a calculation your doctor will make based on a book called the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fifth Edition.
How long do the employer and insurer pay for my medical treatment?
For all injuries which occurred from July 1, 2013 to the present, Georgia law limits the duration of medical treatment you can receive for your injury to 400 weeks. The time limit begins on the date of your accident.
For all injuries which occurred on and before June 30, 2013, and for all catastrophic injuries, Georgia law permitted payment of lifetime medical benefits.
What medical treatment does the insurance company have to pay for?
In Georgia, the workers’ compensation insurance company must provide you with medical, surgical, and hospital care and other treatment, items, and services which are prescribed by a licensed physician. This includes medical and surgical supplies, artificial limbs, and prosthetic devices and aids damaged or destroyed in an accident. This includes your doctors’ visits, hospital visits, surgeries, physical therapy, prescription medication, and medical mileage reimbursement.
However, the medical treatment and devices must be reasonably required and appear likely to effect a cure, give relief, or restore you to suitable employment, in the judgment of the State Board of Workers’ Compensation. If your insurance company is dragging its feet on authorizing medical treatment, it may be stalling or waiting to deny the treatment. Time is of the essence and if your insurance company is not responding to you or your doctor’s request for authorization of medical treatment, you may need to call an attorney.
When do I have to report my Georgia workers’ compensation accident?
Georgia law requires that you report the accident within 30 days of the accident. You must give the notice to your employer, your employer’s “agent” or “representative,” your foreman, or your immediate superior.
If you do not report the accident within 30 days, the insurance company may deny the claim. To overcome a “notice defense” for failure to give notice within 30 days of the accident, you must show you were prevented from giving notice because:
- You were physically incapacitated;
- You were mentally incapacitated;
- Fraud;
- Deceit;
- Your employer, your employer’s agent, your employer’s representative, your foreman, or your immediate superior had knowledge of the accident;
- You can prove to the satisfaction of the State of Board of Workers’ Compensation that you had a reasonable excuse for failing to give notice and your failure to give notice within 30 days had not prejudiced your employer.
What if someone or some company other than my employer caused my Georgia Workers’ Compensation accident?
In Georgia, you cannot sue your employer when you are injured on the job. However, you may file a civil action against a negligent third party who caused or contributed to your injury. This could include the manufacturer of a defective product, the owner of a dangerous property, the driver of a vehicle that hit you, or anyone else whose negligence directly caused/contributed to your harm. In some cases, you may be able to file both a third-party liability claim and workers’ compensation claim for benefits. A third-party liability claim allows you to recover non-economic benefits, such as compensation for pain and suffering, which you are not allowed to recover under Georgia workers’ compensation law.
How much can my workers’ compensation attorney charge?
Georgia law limits a workers’ compensation attorney’s fee to 25% of the worker’s income benefits.
What is an injury under Georgia workers’ compensation law?
Under Georgia law, an “injury” is defined as an injury by accident arising out of and in the course of the employment.
An “injury” includes an aggravation of a pre-existing condition by accident arising out of and in the course of employment, but only for so long as the aggravation of the preexisting condition is the cause of the disability. However, the pre-existing condition is no longer considered an “injury” when the aggravation ceases to be the cause of the disability.
If I was attacked by a co-worker or customer at work, can I receive Georgia workers’ compensation benefits?
You may be able to receive workers’ compensation benefits if you can prove the attack arose out of and in the course of your employment. In other words, you must show the attack was not directed at you for reasons which were personal to you and which were not work-related.
Do I get to choose my doctor in my Georgia workers’ compensation claim?
You can pick a doctor of your choice if your employer fails to post a list of doctors, called a “panel of physicians,” at your place of employment. However, if your employer has a valid posted panel of physicians and lets you pick a doctor from that list, then you must treat with the doctor from your employer’s panel of physicians.
The panel of physicians must have at least six physicians or professional associations or corporations of physicians who are reasonably accessible to employees. At least one of the physicians must be an orthopedic surgeon and there cannot be more two “industrial clinics” on the panel. However, Georgia law does not define “industrial clinic.” The doctor you select from the panel of physicians becomes the “authorized treating physician.” You can make one change from one physician to another on the panel of physicians.
How many doctors must be on my employer’s panel of physicians in a Georgia workers’ compensation claim?
The panel of physicians must have at least six physicians or professional associations or corporations of physicians who are reasonably accessible to employees. At least one of the physicians must be an orthopedic surgeon and there cannot be more two “industrial clinics” on the panel. However, Georgia law does not define “industrial clinic.” The doctor you select from the panel of physicians becomes the “authorized treating physician.” You can make one change from one physician to another on the panel of physicians.
Am I allowed to change doctors in my Georgia workers’ compensation claim?
Yes, you can change doctors in your Georgia workers’ compensation claim. You can make one change of physician on your employer’s panel of physicians. However, if you want to make more than one change on the panel of physicians, then you have to file a request with the Georgia State Board of Workers’ Compensation to make the change of physician.
Am I allowed to settle my Georgia workers’ compensation claim?
Yes, Georgia law allows you to settle your workers’ compensation claim. However, you are probably dealing with a workers’ compensation insurance company adjuster who has far more experience than you with Georgia workers’ compensation claims. If the insurance company is trying to get you to settle your case but you’re not sure what to do, you should consider contacting an attorney.
