An insurance company’s primary goal is to maximize profits for its shareholders. The main way they do this is by minimizing the amount they pay out in claims. Some workers’ compensation insurance companies use delay tactics to slow down the claims process, hoping claimants will eventually give up or accept lowball settlement offers. Below are some of the more common tactics seen in Georgia workers' compensation claims.
When communication falls by the wayside, it compromises your claim. Some adjusters will refuse to answer emails or phone calls promptly to either slow down the claim process, or because they are over worked. The best way to respond to this type of behavior is to keep detailed records of all communication between yourself and the insurance company. Note the dates and times of your requests for information, and keep all written correspondence as proof of lack of communication.
Insurance companies do not want to pay for ANYTHING. Sometimes an adjuster might delay your claim by disputing your injuries or requiring you to undergo multiple medical examinations by doctors chosen and paid for by the insurance company, claiming that pre-existing conditions are responsible for the injury, or trying to prove any injury was caused by a non-work-related event. If an injured worker provides documentation from a personal doctor, workers’ comp adjusters may try to contact the injured worker’s physician directly with “follow-up questions,” when really they are attempting to discredit the doctor’s findings and downplay the severity of the injury.
Even if the claim is ultimately accepted, the punishment for unreasonably delaying/denying a claim is generally not steep enough to prevent this type of behavior. Yet another reason to hire an experienced Georgia workers' compensation lawyer as quickly as possible following a work accident.
It is rarely in your best interest to provide an insurer with a recorded statement before speaking to or hiring a lawyer. An insurer can use your words against you to limit your benefits, or possibly deny your workers’ compensation claim entirely. Consult an attorney immediately if an insurance company asks you for a recorded statement.
Your employer might tempt you to return to work by offering you a light-duty job. However, accepting this type of offer could be used as evidence against you in your workers’ compensation claim. For instance, an adjuster might argue that since you can return to work in a light-duty capacity, you can’t be too seriously hurt, and your workers’ compensation benefits should be reduced or denied.
Medical providers expect payment for their services. However, some adjusters might delay payment to providers or claim they are waiting on authorization to avoid covering your medical expenses. Some adjusters could even argue that specific medical treatments are unnecessary, meaning workers’ compensation benefits won’t cover them. Delaying payment for medical bills can have multiple negative impacts, including a downgrade of your credit rating.
At SWS Accident & Injury Lawyers we are committed to helping you understand your legal rights and fighting against these common delay strategies. If you are experiencing unnecessary insurance delays after a work-related accident, now is the time to get legal help. Give our lawyers a call today at 770-214-2500 for a free consultation.
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.
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.
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.
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.
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.
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:
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.
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.
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.
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.
After a work injury in Georgia, it is normal to have questions and concerns. Below are answers to some of the more frequently asked questions our clients have about workers' compensation following a work accident in Georgia.
Workers’ compensation is an accident insurance program paid by your employer which may provide you with medical, rehabilitation and income benefits if you are injured on the job. It also provides benefits to your dependents if you die as a result of a job-related injury.
Georgia's workers' compensation act is a section of laws contained within the Official Code of Georgia. The workers compensation act is found under Title 34, Section 9 and currently contains 432 sub-sections.
No. Only employers who have 3 or more employees are required to obtain workers' compensation insurance.
No. Railroad workers, domestic servants, and farm laborers are specifically excluded from the protections afforded under Georgia's workers' compensation act. Additionally, independent contractors are not covered unless it can be shown that the employer exercised a sufficient right of control over the independent contractor at the time of a work accident.
Possibly. Georgia residents who are injured while on the job in another state are subject to Georgia's workers compensation as as long as their employment meets certain requirements. These requirement include: the employee was hired while living in Georgia, the employer’s place of business or the residence of the employee is in the state of Georgia, and the job you were hired for was not exclusively for work outside of the state of Georgia.
You are covered from the first minute you start work for an employer.
All Georgia employers are required to post information identifying medical providers you can choose to see following a work injury. This includes:
You are entitled to medical treatment for your injury immediately. You are entitled to weekly income benefits if you are unable to work for more than 7 days. Your first check should be mailed to you within 21 days after the first day you missed work.
If you are injured at work in Georgia, you are entitled to receive medical and income benefits for up to 400 weeks (a little more than 7 1/2 years). If your injury is deemed "catastrophic" in nature, you may be entitled to lifetime benefits.
You are entitled to receive two-thirds (2/3 or 66%) of your average weekly wage, with a maximum benefit amount currently being $800.00 per week.
You will receive what are called permanent partial disability ("PPD") benefits based upon an amount set by law. For example, if you lost an arm or leg, you will receive benefits of 225 weeks.
You are eligible to receive a reduced benefit called temporary partial disability. The amount you receive is based upon your earnings prior to your injury, and can be received for a maximum of 350 weeks following your injury. The maximum temporary partial disability benefit is currently $533.00 per week .
While tough to think about, it is possible that a work accident can cost you your life. In these terrible instances, your dependents will receive two-thirds of your average weekly wage or a maximum of $800.00 per week for death. Your dependents include your surviving spouse/partner, children/step-children, any other family member who can prove you supported them financially at the time of their fatal work accident. A widowed spouse/partner, with no children, is limited to a total amount of $320,000.00 unless he or she remarries or cohabitates in a meretricious relationship. Children are allowed to receive benefits until they turn 18 years old, unless they can show they are attending college, which allows them to receive benefits until the age of 22.
If you have been injured at work give our lawyers a call today at 770-214-2500 for a free consultation.
If you are injured on the job in Georgia, it is important to perform the following steps in order to have a successful claim. Below is a checklist of things to do if you are injured while working in Georgia.
In Georgia, you have 30 days to report your injury to your employer. Although 30 days is the maximum amount of time you can wait to report an injury, the old adage "the sooner, the better" applies. The sooner you report an injury to your employer, the sooner the workers' compensation system can kick in to provide you with medical treatment, and possibly replacement of lost income.
It is also important to report ALL injuries, even if you believe they are small or will heal on there own. Injuries, particularly the older you get, can be tricky. Things that may have healed with rest when you were younger, might now require medical intervention. So it is extremely important to report ALL injuries, no matter how small. Reporting the injury protects you and is the first step in bringing a successful workers compensation claim.
After reporting an injury, you should always ask for medical treatment. Whether it be with a plant nurse, or with a workers' compensation doctor, it is important to have any injury evaluated quickly. Evidence supports the fact that quick medical treatment results in faster recovery time. Additionally, medical providers generally keep detailed records, which will help prove your injury was the result of working rather than being caused by something else.
Most injuries are initially treated conservatively. This type of treatment includes medication, rest, physical therapy, and work restrictions (i.e. no lifting more than 10 pounds). It is important to follow your medical providers instructions in order to increase the chances of making a full recovery. This includes telling your employer that you can not perform your regular job in the event a doctor places you on work restrictions.
Georgia workers' compensation cases can hinge on whether or not you have proper documentation for an injury. It is extremely important to document everything relating to your work accident and injury. So be sure to keep any documents you receive from your employer and any medical providers. It may also be beneficial to start a journal, or take notes, regarding medical treatment you receive and the types of symptoms your injury is causing.
Georgia's workers' compensation system is a specialized part of the law. As such, many of the issues involving a workers' compensation claim are unique and different from common law used in personal injury claims. Due to this specialization, it is crucial to hire an experienced workers' compensation lawyer to maximize the compensation and medical treatment you receive following an accident.
If you, or a loved one, has been injured while working in Georgia. Give our experienced lawyers a call today for a free consultation at (770) 214-2500.
Workplace injuries in Georgia can be devastating and financially costly for employees and employers alike. Even a minor injury that forces an employee to miss work, or limits their ability to perform their normal job duties, can have negative consequences for both employees and businesses. Here a some of the most common work injuries we see through Georgia.
Injuries related to slips and falls are among the most common workplace injuries, accounting for approximately 33 percent of all worker injuries. Falls at work can result from a number of factors, including wet or slippery floors, poor lighting, uneven surfaces, hidden or misplaced cords and other obstacles.
These injuries can vary in their severity but may result in:
Workers across many industries are at risk of being hit by equipment or falling objects, but these injuries occur most frequently at construction sites, factories, and warehouses. These accidents can result in serious injuries that often lead to lengthy recovery periods and significant medical treatment, including surgery and rehabilitation. These injuries can also lead to 3rd party claims against individuals or companies responsible.
Repetitive motion injuries, also know as cumulative trauma, injuries are a common occupational hazard in all industries. In particular, manufacturing and assembly line workers, as well as office workers who use a computer are at an increased risk of developing repetitive motion injuries as a result of their job duties.
Repetitive motion injuries can include conditions such as carpal tunnel syndrome and tendonitis. While these conditions can often be treated conservatively, which means without surgery, theycan be extremely painful and cause decreased mobilization over time.
Lifting injuries can occur anytime someone picks up, carries, or handles a heavy or oversized objects. Lifting is a common activity in almost every industry, and it presents a risk of injury when done improperly or without proper safety equipment.
While these injuries are rarely fatal, they can result in long-term back, shoulder, knee, and hip injuries that make it difficult to carry out normal work duties. When lifting objects of significant size or weight, is is extremely important to observe the proper technique and use any safety devices provided by an employer.
Many industries involve transportation, including taxi services, mail and delivery services, schools and construction. Now that home-delivery services are becoming increasingly popular, more drivers are on the roads than ever before, making accidents inevitable.
These accidents can result in severe injuries that can lead to temporary or permanent disabilities which require extensive medical care. This is particularly true if the accident involves large trucks or buses.
If you have been injured at work give us a call at (770) 214-2500 for a free consultation.
What happens if I miss time from work due to a work related injury in Georgia? If you are injured due to a work accident, and are forced to miss time from your job, you are entitled to be paid income replacement benefits. The types of income replacement benefits available include temporary total disability benefits ("TTD"), temporary partial disability benefits ("TPD"), and permanent partial disability benefits ("PPD").
Temporary total disability, also known as TTD benefits, are available if an injured worker is unable to work at all. Additionally, TTD benefits may be available if an injured Georgia worker is given work restrictions by their treating physician, and the employer is unable to accommodate the work restrictions. For example, if a physician places an injured worker on restrictions of lifting no more than 10 pounds, but the employer does not have a job available that can be performed without lifting more than 10 pounds, the injured worker would be entitled to receive TTD benefits.
Temporary partial disability benefits, also knows as TPD benefits, are available if an injured worker earns less money as a result of a work accident. For example, say an injured worker normally works 50 hours per week, which results in 10 hours of overtime. Following a work accident, the injured worker is only able to work 30 hours per week (because they are only physically able to perform 30 hours of work per week, or because their employer only schedules them to work for 30 hours per week.) In this case, the injured worker is entitled to receive TPD benefits that make up two-thirds of the difference in their pre-injury and post-injury earnings.
Permanent partial disability benefits, also known as PPD benefits, are available to an injured worker to compensate for permanent loss of an injured body part. In the event a physician says there is no additional medical treatment available that can improve an injured workers condition, and the injured worker continues to be limited physically due to the work injury, the treating physician will give the injured worker an impairment rating. The rating, usually given in a percentage of a body part (i.e. 5% to the arm, or 7% to the lower extremity), is then converted to a number of weeks based on a chart found in O.C.G.A. §34-9-263. For example, say an injured worker is given a 5% PPD rating to their arm. Looking at the chart below we see an arm is eligible for a maximum of 225 weeks of benefits. 5% of 225 = 11.25. So in this scenario, an injured worker would be entitled to PPD benefits in the amount of 11.25 weeks worth of income benefits.
|Body part injured||Maximum weeks allowed for PPD Benefits|
|1st (index) finger||40|
|2nd (middle) finger||35|
|3rd (ring) finger||30|
|4th (little) finger||25|
|Great (big) toe 30||30|
|Loss of hearing (one ear)/total industrial||75|
|Loss of hearing (both ears)/total industrial||150|
Georgia law requires an employer/insurer send weekly checks to an injured worker who is unable to work, or who now earns less, due to their work injury. If the payment is late, it is possible that the employer/insurer also owe an additional 15% late payment penalty.
An injured Georgia worker is entitled to receive 2/3 of their average pre-injury wage. In order to calculate the injured workers average pre-injury weekly wage, Georgia law requires the use of injured workers earnings for the 13 weeks preceding the injury. Included in these earnings are overtime, commission, and other monetary benefits provided by an employer. As of July 1, 2023, the maximum weekly TTD is $800, while the maximum weekly TPD benefit is $533, and maximum PPD benefit is $800 per week. The maximum cap on weekly benefits has changed over time. The chart below demonstrates the applicable weekly benefit cap based on the date of the injury.
|Date of Injury||Maximum TTD weekly payment||Maximum TPD weekly payment||Maximum PPD weekly payment|
|July 1, 2023 - present||$800||$533||$800|
|July 1, 2022 – June 30, 2023||$725||$483||$725|
|July 1, 2019 – June 30, 2022||$675||$450||$675|
|July 1, 2016 – June 30, 2019||$575||$383||$575|
|July 1, 2015 – June 30, 2016||$550||$367||$550|
For example, a worker who earns $900 per week is entitled to receive TTD benefits in the amount of $600 per week until they are able to physically return to work. This is because $600 is 2/3 of their pre-injury average weekly wage.
Another example would be an injured worker who earns $1,500 per week. Although 2/3 of their average weekly wage is $1,000, Georgia law caps the weekly benefit at $800. So in this scenario, the injured worker would only be entitled to receive $800 per week in TTD benefits.
An injured Georgia worker can receive TTD benefits for a maximum of 400 weeks following their work injury. The maximum time period to receive TPD benefits is 350 weeks from the date of the injury.
Georgia's workers' compensation law is very specialized and nuanced. It is extremely important have an experienced Georgia workers' compensation lawyer to help maximize the value of your case and ensure you receive all the benefits you are entitled. Give our battle tested lawyers a call today for a free consultation 770-214-2500.