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Wondering how workers' comp works in Georgia? Check out this guide to learn everything you need to know.

About Georgia's Workers' Compensation System

Before Georgia's state government established a system for worker's compensation, employees had no rights to benefits from their employers if they were hurt on the job. In the 19th and early 20th centuries, working conditions were severe and even dangerous, and workers did not have legal options when injured – even if that meant a lifetime of disability.

What Injury on the Job Meant in the Past

Employees around the turn of the 20th century technically could file lawsuits, but these legal actions were generally unsuccessful and brutal for all involved. The trials were long and expensive, and businesses suffered severe brand damage. Injured workers, meanwhile, often came away from experience with no way of paying for medical bills and other costs.

Both sides of the labor equation realized something big needed to change. So they eventually struck a grand bargain: workers would relinquish their right to sue for injuries at work (with some exceptions) in exchange for guarantees for compensation.

In 1920, the Georgia State Legislature instituted the State Board of Worker's compensation to oversee this process. Today, the Board serves over 250,000 Georgia employers and over 3.8 million employees. It receives funding from self-insured employers and insurance company assessments. Any Georgia worker injured at work and covered under the law may be entitled to compensation for lost wages, medical bills, and physical therapy services, among other benefits.

How Georgia's Worker's Compensation Laws Affect Today's Workforce

Georgia's current worker's compensation law applies to all employers with three or more full-time or part-time employees, including public corporations and non-profits. The law allows employees with job-related injuries to receive specific benefits without regard for negligence or fault. It also provides employers with limited liability.

Per state regulations, Georgia employers receive coverage for worker's compensation either through private insurance companies or self-insurance programs. In addition, a worker's rights under the worker's compensation law disqualify them from taking other legal action against the employer in the event of a work-related injury.

A Closer Look at Georgia's Workers' Compensation Laws

Most Georgia employees know little about the state's workers' compensation program and what happens if they're injured at work. This lack of understanding can make the compensation process extraordinarily confusing and stressful. Keep reading to learn more about workers' compensation laws in the state of Georgia.

Penalties for late payments may be assessed in several states, but they are lower in Georgia than in many regions. Depending on the situation, the employer may be required to pay a 15 percent penalty. This penalty can be assessed if benefits were inappropriately denied or the employer simply forgot to send a payment. For this reason, it behooves injured employees in Georgia to keep track of worker's compensation payments and to take note when they do not arrive on time.

Under Georgia law, worker's compensation cases are either catastrophic or non-catastrophic. Typically, a patient is deemed destructive if the injured employee qualifies for Social Security disability benefits. Injuries considered catastrophic include limb amputation, severe brain injury, and industrial blindness.

Georgia employers must maintain a list of six approved doctors employees can visit after injury. In an emergency, employees can obtain treatment from a doctor not included on this list. Still, in all other situations, the physician treating the workplace injury must be one of the employer's six approved medical professionals. Unfortunately, many employers choose physicians they feel will take their side should employees pursue worker's compensation. As a result, injuries may be blamed on preexisting conditions rather than workplace mishaps.

The State Board of Workers' Compensation reports that 39,899 indemnity claims occurred in Georgia in 2014. As a result, indemnity benefits in 2014 totaled $1,056,193,486. Additionally, 830 WC-26 forms indemnity forms were filed that year.

In 2013, Georgia significantly changed its workers' compensation model: many workers were suddenly ineligible for benefits after eight years. As a story from NPR and ProPublica points out, this means that those with knee or hip replacements no longer qualify for coverage if, after a decade, their mobility devices wear out. In the most severe cases, however, injured workers may still be eligible for long-term compensation.

Workers' compensation in Georgia is far from perfect, but as another ProPublica story points out, employees enjoy far greater compensation than those residing in Alabama. For example, in a report comparing similar injuries across state lines, ProPublica revealed a maximum payment of $118,125 for Georgia workers who lose their arm, compared to just $48,840 for the same damage in Alabama.

Workers' compensation varies significantly from one state to the next. You could obtain significant compensation for your workplace injury as a Georgia resident. Still, your chances of claim acceptance are far greater if you work with a trusted workers' compensation attorney.

The more you know about workers' compensation in Georgia, the better. Contact Smith, Wallis, and Scott, LLP, today for more information.

The State Board of Workers' Compensation reports that 31,500 indemnity claims occurred in Georgia in 2021. Indemnity benefits, or replacement of lost wages, in 2021 totaled $706,673,059. https://sbwc.georgia.gov/organization/about-state-board-workers-compensation/statistics

Understand Where Exceptions Apply

While the law applies broadly to most employees in the state, there are some exceptions. For example, federal employees, railroad workers, farm workers, and domestic servants are exempt from Georgia's worker's compensation law.

A separate agency, the Subsequent Injury Trust Fund, works with the State Board of Worker's Compensation to reimburse employers and insurers for a part of worker's compensation benefits. This secondary agency oversees cases where an employee has a preexisting injury or disability, and a work-related accident worsens.

Fault Or No Fault? That Is The Question.

This morning I was on my Thursday morning radio show, and a caller asked, "If I am injured on the job, and I was at fault, can I still get worker's compensation in Georgia?"

Simple answer: YES!

This is the beauty of the Georgia Worker's Compensation system. Even if you cause the accident, you can still recover. The question is not whether it is your fault or someone else's fault. The question is, "Is your injury causally related to your job duties?"

What does this mean? This means that your injury is related to your job.

Let's suppose that one day you are at work and you decide to lift a pipe that weighs 300 lbs even though you know you can't lift 300 lbs and your boss has told you that you should wait for help before you lift the 300 lbs. But you go to pick up the pipe and drop it right on your foot, fracturing every bone.

You are still covered under workers' compensation. The reason is that you performed your duties when the accident happened. It may not have been an excellent decision to do what you did, but that doesn't matter.

However, if you lift the same pipe and then feel pain in your body and go in, and the doctor says you have cancer, this would not be workers' compensation because cancer could not have been caused by lifting a pipe.

Fault or no fault, it just doesn't matter.

If you have been injured at work, call us now. We will provide a free consultation and let you know whether your injury is covered under the law.

What If You Were Sick or Disabled Before Your Work Injury?

Preexisting conditions can quickly complicate otherwise straightforward Georgia workers' compensation cases. A preexisting condition won't necessarily bar you from receiving the benefits you want. Still, you will need extensive documentation indicating that your job exacerbated the situation and led to greater suffering.

The Burden of Proving That the Workplace Incident Worsened the Condition

Employees afflicted with preexisting conditions may be eligible for workers' compensation if workplace duties lead to more severe symptoms. But your employer is only responsible for worsening your condition — not the condition itself. You might be similarly entitled to damages if a previous workplace injury was re-aggravated at your present job. The claim amount may be lowered to accommodate previous workers' compensation claims in such cases.

The Workers' Compensation Act and Preexisting Conditions

Georgia's Workers' Compensation Act significantly limits the extent to which employees with preexisting conditions can seek compensation; compensation is only available when work-related aggravation causes the disability. Once an employee returns to a pre-injury state, the Workers' Compensation Act mandates that payment cease.

Recent changes in legislation have limited compensation for re-aggravated conditions to 400 weeks from the date of the accident. However, lifetime medical benefits may be available for catastrophic injuries or those before June 30, 2013.

Providing Appropriate Documentation

Whether your preexisting condition occurred at work or in some other capacity, you will need to document your previous injury and its impact on your life before your most recent workplace injury. Decrease workers' compensation denial likelihood by seeking documentation from your physician or federal agencies that provided previous workers' comp benefits. Supplement this with proof of your current disability, including recent tests and medical records. If employer-approved physicians deny your condition, seek further feedback from an independent medical professional.

If you've suffered a worsening of a preexisting condition in the workplace, contact Smith, Wallis & Scott, LLP today to learn more about filing for workers' compensation.

What If I Refuse to Work?

It would be great if, when you were injured, you never had to return to work while recovering. But unfortunately, this is never the goal of the insurance company. The purpose of the worker's compensation system is for you to be back to work.

What happens when you are asked to return to work and do not believe you can return to work? Can you refuse to work?

The answer is yes, but only in certain situations. For example, if you have been injured and taken entirely out of work by your authorized physician, you would not have to return to work until the doctor has either released you to regular duty or placed you on duty work restrictions.

If you have been placed on light duty work by your doctor, the insurance company would have to find a suitable light duty job, have the doctor sign off on the job approving it as appropriate, and then file a form WC-240. Lastly, they must give you ten days' notice to return. If all of this happens, you must return to work. (If the job is not the job on the description, you are allowed not to perform the job. Contact an attorney before you make this decision).

Suppose you have been released to regular duty by your authorized treating physician. In that case, you must return to work until you find that another doctor has completely taken you out of work or placed you again on light duty.

Either way, if you have been released to light duty and have been asked to go back to work and you feel that you are not able or have been released to regular duty, it is essential to contact an attorney to make sure you are protected.

Maximizing the Income Benefit

Georgia workers' compensation is an incredibly unique animal. Unlike a personal injury case where the judge or jury decides the case and the damages are awarded based upon the injury, wage loss, and pain and suffering, in Georgia, an injured worker is only entitled to certain measurable and enumerated benefits. Therefore, there is no entitlement to a settlement. However, with the help of an attorney, an injured worker can receive compensation by using these benefits outlined in the law to plug into a "formula" for determination. But this is not simply a 1+1 formula. Instead, it is based upon the projected value of benefits owed, the likelihood of success on the case, and the probability of the injured worker improving health. This is where a skilled attorney comes into play.

Part of this formula for determining the settlement value of a case is a weekly wage check paid for by the insurance company. The check is not the full check you received when you were working. Instead, it only reflects your actual wage, coming to approximately 66% of your wage. That is 66% of your wage for earnings up to $550. This means if a person earns more than $833 per week, the most they would receive is $550. For example, if the injured person were earning $1,500 per week, they would receive $550.

Although not a tremendous improvement, Georgia HB 818 was just approved, and beginning on July 1, 2016, the maximum income benefit for an injured worker will go up to $575. This sounds like a slight increase. However, the increase comes to almost $10,000 increase over the entire life of a case.

This benefit will not be retroactive but at least will help injured workers from July 1 and continue receiving a greater portion of the benefits they deserve.

What is Social Security Disability and How Do I Apply?

According to the Social Security Administration, studies show that a 20-year-old worker has a three-in-ten chance of becoming disabled before reaching retirement age. When a person suffers from a debilitating mental or physical disability, they may be eligible to receive Social Security Disability benefits from the government.

The Social Security Administration pays disability benefits under two different programs: 

• Social Security Disability Insurance (SSDI) - Based on prior work for which Social Security Taxes were paid.

• Supplemental Security Income (SSI) - Based on financial need. Children, as well as adults, may be able to collect disability benefits. 

Unfortunately, meeting Social Security's definition of disability benefits is often challenging. That's where you could use the help of an experienced SSDI attorney, like the ones at SWS Accident & Injury Lawyers.

Our attorneys are thoroughly familiar with both programs and can work with you to help get you the benefits you deserve and desperately need. We have successfully represented hundreds of claimants, helping them obtain Social Security benefits after previously being denied. 

Social Security Administration Defines "Disability"

We all know what "disability" means, but this term has a specific definition in the context of the Social Security disability program and the Supplemental Security Income (SSI) program. A person with a "disability" has the inability "to engage in any substantial gainful activity by reason of any physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. 423 (d)(1)(A) and 1382c(a)(3)(A).

"Substantial gainful activity" is another specific term defined by Social Security, and we will discuss this in our next blog. However, the big takeaway from the definition of disability is this: it deals with a severe health condition that interferes significantly with one's ability to work and must last or be expected to last 12 continuous months. This is why Social Security requires so much paperwork about a claimant's physical and mental abilities; it must decide how those abilities affect the claimant's functioning in a work setting.

Who Qualifies for Social Security Disability Benefits in Georgia?

Social Security Disability (SSD) exists to assist individuals who have paid into the Social Security system when they can no longer work.

How do you qualify to receive these crucial benefits? 

In general, you need to have worked in a job where the government deducted Social Security taxes from your pay; and you must have a medical circumstance that meets the Social Security Administration's definition of a disability.

The Definition of Disability

Social Security defines "disability" somewhat differently than other entitlement programs. The system only pays for total disability; individuals are not eligible for partial or short-term disability. This fact distinguishes SSD from similar programs like worker's compensation. The government considers someone disabled if they meet all of the following criteria:

• The individual is unable to work as they previously did;

• The Social Security Administration (SSA) determines that the individual is unable to adjust to different work due to their medical condition;

• The individual's disability has lasted (or is expected to last) for one year or more, or physicians expect the individual to die soon.

The SSA uses a strict definition of disability; this is why many Social Security Disability claims are denied. The Georgia SSD department approves about 30% of the claims that come through its office.

Your Contribution to the Program

The amount a person has worked and paid into the Social Security system is the other factor determining who is eligible for Social Security Disability benefits. Every year you work, you earn Social Security credits based on your yearly wages or income from self-employment.

The number of credits you earn will vary yearly, but four credits each year is the maximum. To qualify for Social Security Disability benefits, you generally need 40 credits, 20 of which should be earned in the last ten (10) years of your employment.

Although the government created SSD benefits for those who have spent their lives working, it is possible to qualify for them at a younger age. For example, if you become disabled before age 24, you can be eligible for benefits if you earned six Social Security credits in the three years leading to your disability.

Conditions that may qualify you for SSDI benefits

There is a list of approved diagnoses that will make you eligible for benefits, but that isn't a promise. Some conditions that may qualify an individual for Social Security benefits include:

• Depression/anxiety

• Blindness

• Arthritis

• Heart disease

• Paralysis

• Orthopedic injuries

• Diabetes

• Neurological disorders

Again, getting a diagnosis from this list does not guarantee the benefits you seek, but if you keep good records and submit appropriate paperwork, you are well on your way. You might be wondering if it is possible to expedite the process, but there are very few ways to rush the SSD process. If your conditions are more severe, look into the qualifications for the Compassionate Allowances Program. It is one of the only ways the government will expedite your SSDI case.

What Is The Compassionate Allowances Program, And How Does It Work?

Following a lengthy application process, you may wait weeks, even months, to hear back about Social Security Disability benefits. During that time, your bills could pile up quickly, especially if your disability leaves you unable to hold down full-time work. However, suppose your condition is unusually severe. In that case, you may be eligible for expedited approval via the Compassionate Allowances Program, which provides prompt assistance for those with serious (often terminal) medical conditions.

Which Conditions Qualify For the Compassionate Allowances Program?

The Compassionate Allowances Program maintains a list of over 200 conditions that qualify for expedited disability benefits. These include:

What Evidence Is Needed?

The process of proving eligibility for the Compassionate Allowances Program is surprisingly simple, although it varies somewhat based on the applicant's condition. More evidence is always better, especially as hospitals and clinics can sometimes be slow to respond to inquiries. Biopsy reports, discharge summaries, and physician letters are helpful and can pave the path to quicker acceptance.

Processing Timeline For Compassionate Allowances Program Applications

Typically, it takes several months to determine whether an individual is eligible for Social Security benefits. With the Compassionate Allowances Program, this decision is made in a matter of days. Unfortunately, the usual SSDI waiting period applies after approval or denial is granted. Established by federal law, this five-month waiting period cannot be waived, even for those accepted through the Compassionate Allowances Program.

The Compassionate Allowances Program can spell the difference between months of suffering and prompt financial relief. If your suffering is severe, and you cannot afford to wait for a disability determination, this program may be your best option.

How To Prove Your Medical Condition for Social Security Disability

Medical evidence is an integral component of any bid for disability benefits. When you file a disability claim, you are responsible for providing ample evidence of your condition and how it impacts your day-to-day life. This evidence must come from reliable sources who have treated your condition.

Tracking your condition can be tricky, but thankfully, you have many resources at your disposal. The Social Security Administration can help you obtain the necessary information if you provide permission, or you can turn to a Social Security disability lawyer for help. Keep the following considerations in mind as you track your condition:

Seek Evidence From Approved Sources

According to the Social Security Administration, accepted sources of disability evidence include:

Additionally, the SSA may request copies of reports from clinics, hospitals, or even social workers. These reports may include the following:

Tracking Symptoms On Your Own

Your personal records of your symptoms will not be enough — you need feedback from licensed medical professionals. However, healthcare professionals will likely advise you to keep a detailed history of the symptoms you experience. Whenever an incident related to your impairment occurs, please take note of what happened, when it happened, and how much pain it caused. Avoid exaggerating or minimizing your condition, as this could lead to claim denial. Careful tracking of symptoms is essential for representative payees, who must record medical incidents and associated expenses.

The right Social Security attorney can help you locate the medical records and documents needed to support your claim. Look to Smith, Wallis & Scott, LLP for assistance filing for disability benefits and appealing denied claims.

How Can I Help Someone Apply for Social Security Disability?

Suppose your significant other, parent, sibling, or friend desperately needs Social Security Disability Insurance or Supplemental Security Income, but cannot apply for those benefits or follow through with the approval process. Now, it's up to you to secure the disability benefits your loved one requires. Keeping reading to learn more about this big responsibility:

Develop a Clear Understanding of the Impact of Your Loved One's Disability

Your loved one may be unable to communicate the full extent of their suffering. Be careful not to underestimate the pain this person is experiencing. Carefully observe what the disability applicant can and cannot do as a result of their condition, and be prepared to report on these observations.

Be Prepared to Act as a Representative Payee

The Social Security Administration appoints a representative payee to manage benefits on behalf of those who are too ill to do so themselves. The payee's job is to use the awarded benefits to pay for necessary care and save benefits that are not needed. The payee must also keep a clear record of these expenses and savings. The Social Security Administration recommends that payees act not only in the financial interests of the beneficiary, but also take an active role in that person's life.

Applying to Be a Representative Payee

If you already have power of attorney, you'll still need to apply to be your loved one's representative payee. The application process is simple, but it typically occurs in person. Complete form SSA-11, and be prepared to show documents that prove your identity.

As a representative payee, you can positively impact your loved one's life. Take your duties seriously — you are the integral link between your loved one and the care they desperately need.

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