Do I Sue My Employer if I am Injured at Work in Georgia?

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Most of the time when someone thinks about being compensated after an injury in Georgia they think about filing a lawsuit.  Visions of lawyers, judges, juries, and courtrooms may run through your mind.  Well in Georgia, it is a little different.  In Georgia, a workers' compensation case is a hybrid.  It begins as an insurance claim, that if not handled properly, can turn into a lawsuit.

In order to fulfill the hybrid insurance/legal requirements the workers' compensation act, the legislature created the Georgia State Board of Workers' Compensation. The State Board's duties include handling the insurance claim portion, as well as any claim that turn into a lawsuit.  Read further for a more in depth explanation on the structure of the Georgia State Board of Workers' Compensation and how it works.

What is the Georgia State Board of Workers' Compensation?

Established in 1920 by the Georgia legislature, the Georgia State Board of Workers' Compensation is tasked with implementing Georgia's workers compensation act.  The Board serves over  3.8 million Georgia workers as well as 250,000 Georgia employers.  The State Board is funded by assessments from insurance companies and self-insured employers.

What does the Georgia State Board of Workers' Compensation do?

The Georgia State Board of Workers' Compensation is tasked with implementing all aspects of the workers' compensation act.  This includes keeping records of claims, conducting hearings, approving settlements, and investigating fraud.

What is the structure of the Georgia State Board of Workers' Compensation?

The State Board is comprised of several levels and divisions.

  1. Chairman - Appointed by the Governor of Georgia.  Highest position in the State Board.    Also serves as a judge in Appellate Division cases.
  2. Directors (2) - Appointed by the chairman.  Serve as judges in the appellate division.
  3. Executive Director - Appointed by the chairman.  In charge of day to day operations of the State Board.
  4. Administrative Services - In charge of running the State Board offices.
  5. ADR (Alternative Dispute Resolutions) - In charge of mediations and similar services.
  6. Appellate Division - Responsible for hearing appeals from hearing decisions.  Consists of the 3 judges (Chairman and 2 Directors.)
  7. Claims and Document Processing - In charge of filing and processing claims and other types of paperwork.
  8. Enforcement Division - In charge of investigating compliance with the workers' compensation act including fraud and ensuring proper insurance coverage for employers.
  9. Information Technology - Responsible for maintaining ICMS, which is the electronic filing system implemented by the State Board.
  10. Legal Division - Consists of Administrative Law Judges who preside over legal hearings, rule on motions, etc.
  11. Licensure & Self-Insurance - Responsible for licensing insurance companies to provide coverage for employers.
  12. Managed Care & Rehabilitation - In charge of policing individuals involved in catastrophic cases, such as CAT suppliers and nurse case managers.
  13. Settlement Division-  In charge of reviewing and approving settlements.

Does the Georgia State Board of Workers' Compensation make the law?

No.  The Georgia State Board of Workers' Compensation is an administrative body that is limited in it's authority by law passed by the legislature and signed by the governor.

Does the Georgia State Board of Workers' Compensation make rules?

Yes.  The legislature has given the State Board permission to pass rules to help implement laws passed by the legislature.  The Board generally updates the rules yearly, with new rules coming into effect on July 1.

How does the Georgia State Board of Workers' Compensation decide what rules to make/change?

Since 1994, any changes or addition to the Board Rules are supposed to be vetted and approved by an entity known as the Advisory Council.   The Advisory Council is a group of leaders from all aspects of workers' compensation--insurance, labor, medical, legal, small business, and business.  This includes lawyers, insurance executives, business/ corporate representatives, medical providers, and members of the State Board.  The Advisory Council is composed of 6 committees.  These include:

  1. Legislative
  2. Licensure
  3. Medical
  4. Public Education
  5. Rehab
  6. Rules

Every year the Advisory Council meets during the first week of October to come up with changes to the Board Rules, recommendations to send to the legislature for changes to the workers' compensation act, and addressing any other concerns with the entire workers compensation system.  Since it's inception there has been a "gentleman's agreement" to only propose Rule changes, and changes to the law, which are agreed to by consensus amongst members of the Advisory Council.  Although recently the State Board has chosen to make some changes over the objections of certain groups.  Our firm has been fortunate enough to have one of our lawyers, Joseph Brown, appointed by the Chairman of the State Board as a member of the Advisory Council since 2019.  As such, Joseph spends the first week of October fighting to improve the types of  benefits and medical treatment workers injured workers are able to receive.

How does a Georgia workers' compensation claim turn into a lawsuit?

In the event a party believes the other side is not performing their duty involving a claim, the aggrieved party can request a hearing in front of an administrative law judge ("ALJ").  An ALJ is able to conduct court hearings where they receive evidence and testimony, evaluate legal arguments, and issue legal opinions.  These hearings are similar to what you might think of, when you think of court.  The main difference is there is no jury.  The ALJ is the ultimate decision maker on who is right and who is wrong in any workers' compensation dispute.

Can I appeal a decision from an Administrative Law Judge?

Yes.  You can appeal a decision of an ALJ to the Appellate Division.  The Appellate Division consists of 3 judges (Chairman and 2 Directors) who will hear the appeal and issue a decision.

What if I disagree with a decision of the Appellate Division?

You can appeal any decision by the Appellate Division to the Superior Court of the county where the work injury occurred.  After the Superior Court, a case can be appealed to the Georgia Court of Appeals, Supreme Court of Georgia, or ultimately the Supreme Court of the United States.  It is important to note that you have a right to appeal any decision up to the level of the Superior Court.  Any appeal to the Georgia Court of Appeals, Supreme Court of Georgia, or Supreme Court of the United States is only allowed if the given Court grants an application for appeal, also knows as granting "certioari".

 

If you have been injured at work and need help navigating the winding road of Georgia's workers' compensation system, give our lawyers a call today at 770-214-2500 for a free consultation.

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