Who Is Eligible for Georgia Workers’ Compensation?
In Georgia, most employees are eligible for workers’ compensation benefits if they are injured on the job. All Georgia employers with three or more employees, whether full-time, part-time, or seasonal, must purchase workers’ comp insurance coverage. This means eligible employees include those in construction, manufacturing, healthcare, and numerous other industries. However, independent contractors, domestic workers, and some agricultural workers may not qualify. Additionally, failure to meet reporting and other requirements may render an injured employee ineligible for benefits.
Workers’ Compensation Benefits in Georgia
When an employee suffers a work-related injury in Georgia, the state’s workers’ compensation system can provide various defined financial benefits to help the worker recover. Workers’ compensation can also provide financial benefits to qualifying dependents if a worker suffers a fatal occupational injury.
Medical Benefits
Workers’ comp medical benefits cover the cost of all reasonable and necessary medical treatment for a work injury or occupational illness. Some examples of expenses covered by workers’ comp include emergency care, hospitalization, pain management, medical equipment, and physical and occupational therapy. Medical benefits typically continue until a worker reaches maximum medical improvement, which is the point at which no further medical treatment will likely improve their physical condition.
Workers’ Compensation Supplemental Income
Injured workers who miss work can obtain partial reimbursement of their lost income, including total loss of income from missed days or reduced earnings while on modified duty required by doctor-imposed medical restrictions.
Rehabilitation Support
Severely injured or disabled workers can request vocational rehabilitation services paid for by their employers. Vocational rehabilitation can include job training to perform work within a person’s physical limitations, vocational evaluations, career counseling, and job placement services.
Death Benefits
Eligible dependents of a worker who passes away due to a work injury can receive death benefits that include a financial contribution toward funeral and burial expenses. In addition, they may receive financial payments equal to two-thirds of the worker’s average weekly wage at the time of their accident, subject to caps set by state regulations.
How Georgia Workers’ Compensation Payments Work
Employees who miss work or develop disabilities due to work injuries may be eligible for financial payments to compensate for lost income or earning capacity.
Types of Payment for Workers’ Compensation
Workers who get hurt at work may become eligible for various financial benefits offered by the Georgia workers’ compensation system, which include:
Temporary Partial Disability Payments
Workers still recovering from work-related injuries who can return to work in a restricted capacity that pays less than they earned before their injury can receive temporary partial disability benefits. These benefits reimburse two-thirds of the difference between the worker’s pre-injury wage and their reduced post-accident wage.
Temporary Total Disability Payments
Workers who miss more than seven days from work become eligible to receive temporary total disability benefits. These benefits partially reimburse the worker’s lost wages from missed work equal to two-thirds of the worker’s pre-injury average weekly wage. Once the worker misses 21 consecutive days from work, they will receive reimbursement for the first seven missed days.
Permanent Partial Disability Payments
After a worker reaches maximum medical improvement and has sustained:
- Permanent loss of use of a body part or function or
- Loss of a body part that does not render them completely disabled from working
They can receive partial permanent disability payment on a formula that accounts for the nature and severity of their disability.
Lump-Sum Payments for Georgia Workers’ Compensation
Workers can also negotiate a settlement of their workers’ compensation claim to secure a lump-sum payment, which can help them resolve medical or other debts they incurred while pursuing their claim.
How Are Wages Calculated for Workers’ Comp?
Georgia’s workers’ compensation system bases disability benefits on a worker’s pre-injury average weekly wage. To calculate a worker’s average weekly wage, the insurance company calculates their total gross pay earned in the 52 weeks before their injury and then divides that figure by 52 to arrive at the weekly average. Calculating disability benefits requires including all the income a worker earns from each job if their injury prevents them from working that job.
Furthermore, Georgia caps the amount of temporary disability benefits a worker can receive. This cap increases regularly to account for inflation.
Steps to File a Workers’ Compensation Claim in Georgia
After getting hurt at work, you must follow several steps to file your workers’ compensation claim and pursue the benefits you deserve under Georgia’s workers’ comp system:
Notify Your Employer
First, you must notify your employer about a workplace accident and your work injury as soon as possible, and absolutely within 30 days. Providing written notice to your employer protects your rights by establishing a record of when and to whom you gave notice. Your employer may have forms to fill out to report your work injury; otherwise, you can notify a supervisor, human resources representative, or company manager.
Obtain Medical Treatment
Next, you should seek immediate medical attention to begin treatment of your injury. Although you may seek emergency medical treatment anywhere, Georgia’s workers’ compensation system gives your employer the right to require you to use approved physicians to oversee your treatment. Your employer can either post a list of six doctors for you to choose from or provide contact information for the employer’s managed care organization that can put you in touch with an approved physician. You may switch to another approved physician once without your employer’s permission, if the first one isn’t a good fit.
File Workers’ Compensation Claim Form WC-14
Although your employer must report your injury to its workers’ compensation insurer, you can protect your rights to workers’ comp benefits by filing Form WC-14 with the State Board of Workers’ Compensation to ensure it receives notice of your injury.
Your Employer Will Submit Your Claim
Your employer must submit an Employer’s First Report of Injury or Occupational Disease to its workers’ compensation insurer. The insurer will complete the form and forward it to the State Board.
What Happens After Filing a Workers’ Compensation Claim?
When you report a work injury, the law requires your employer and its workers’ compensation insurer to investigate your claim within 21 days and file an Employer’s Report of Injury with the Georgia State Board of Workers’ Compensation. Your employer and its insurer will either accept your claim, accept your claim while reserving the right to investigate further, or deny your claim. When your employer accepts your claim, you can begin receiving workers’ compensation benefits, including having your medical expenses covered by your employer and receiving wage loss benefits if you miss more than seven days of work.
Independent Medical Exams
In some cases, your employer may require you to undergo an independent medical exam (IME) as part of its investigation of your injury claims. In an IME, a physician other than your treating physician will examine you, review your medical records, and perform diagnostic tests to determine the nature of your injuries or condition. The employer or insurance company will cover the cost of the IME.
Independent medical exams technically help workers and employers resolve disputes over the existence and nature of work injuries. Insurers may request IMEs to confirm the work-related nature of the injury or the necessity of treatment proposed by the worker’s physician. However, because the employer or insurer schedules the IME, they may do so with a physician who’s more likely to issue a report favorable to the insurance company. An insurer may use an IME report unfavorable to the worker to petition the State Board to reduce or terminate their benefits.
Fortunately, workers who have received wage loss benefits within the past 120 days can request an IME performed by a physician of their choosing. The employer or insurer will cover the cost of that IME.
Settling a Workers’ Compensation Claim
Depending on the nature of your injuries, you may benefit from pursuing a settlement of your workers’ compensation claim. Workers’ compensation settlements can take various forms. In most cases, the insurer will want to negotiate a “full and final” settlement, in which a worker releases the insurer and employer from any future liability for a specific work injury in exchange for financial benefits, which allows the insurance company to close the worker’s file. However, insurers may also agree to settle the issue of disability benefits while allowing the worker to continue making claims for medical benefits.
Insurers can agree to lump-sum settlements, in which a worker receives the total settlement value in one payment, or structured settlements, in which the insurer pays the settlement over multiple checks.
The State Board of Workers’ Compensation must approve all workers’ compensation settlements in Georgia. Once a worker and insurance company settle a case, they must submit a file to the State Board containing documents to allow the board to evaluate the fairness of the settlement, including:
- A copy of the settlement agreement or a document outlining the settlement terms
- All claim forms in the case, including the Employer’s First Report of Injury
- The worker’s medical records
- Any records regarding the worker’s unpaid child support obligations
- The worker’s fee agreement with their workers’ compensation attorney or other agreements the worker has with their lawyer
How Long Will It Take to Get a Settlement Check?
Once a worker and an insurance company agree to a settlement, it can take a couple of weeks for the worker to receive their settlement check or first installment check. First, the worker’s attorney and the insurance company must finalize the settlement agreement and gather the documentation needed to submit along with the agreement to the State Board for approval. The State Board will take a couple of weeks to review the parties’ submissions.
In most cases, the State Board will automatically approve the settlement, after which the insurance company will take about a week to issue the settlement check. However, suppose the State Board has concerns about the fairness of the proposed settlement. In that case, it may schedule a hearing requiring the parties to explain the settlement process and justify the settlement’s fairness, which can increase the time the worker must wait to receive their settlement check.
How Long Do Most Workers’ Comp Settlements Take?
The duration of the workers’ compensation settlement process will depend on several factors. Some of the circumstances that may affect how long it will take for you to finalize a settlement and receive payment include:
- The nature and severity of your injuries
- How long it takes for you to reach maximum medical improvement
- The complexity of the evidence in your case, including the medical evidence of your injuries or disabilities
- Whether your employer denies liability or contests the nature of your injuries
- Whether you need to file a formal workers’ comp claim or pursue a formal hearing
- The duration of the settlement negotiations
- Whether you negotiate a lump-sum or structured settlement
- Whether the State Board requires a hearing to determine whether to approve your settlement
Time Limitations
The law limits the time a worker has to notify their employer of a work-related injury and file a workers’ compensation claim to receive benefits. Failure to file in time may result in forfeiture of the right to the benefits they deserve.
What Is the Georgia Statute of Limitations for Workers’ Compensation Claims?
Under Georgia’s workers’ compensation system, an employee should report work-related injuries to their employer as soon as possible to protect their eligibility for workers’ comp benefits. They’re required to report a work injury to their employer within 30 days; otherwise, they might jeopardize their right to benefits.
However, when an employer does not process or denies a workers’ compensation claim or after an employee receives treatment paid for by workers’ comp, an injured worker has one year to file a notice of claim with the Georgia State Board of Workers’ Compensation. When employees have their wage loss benefits terminated by an employer, they must file their notice of claim within two years of the last date they received them.
Appealing a Denied Workers’ Compensation Claim
Sometimes, an employer or workers’ compensation insurer may deny an injured worker’s benefits claim. Some of the common reasons why an employer or insurer may deny a workers’ comp claim include:
- The worker does not qualify as an employee
- The worker’s injury did not occur in the course and scope of their employment
- The worker failed to report their injury promptly
- The worker’s injury arose from a pre-existing injury or condition
- The worker has fully recovered from their injury without incurring medical expenses or lost income
- The worker got hurt due to misconduct, such as working while intoxicated or engaging in horseplay
Often, an employer or insurer may deny a workers’ comp claim because the worker provided insufficient information to establish their eligibility for benefits. When this happens, workers can pursue appeals of denied claims.
What Happens If Your Employer Denies Your Workers’ Compensation Claim?
When your employer or its insurer denies your claim, you can continue pursuing the financial benefits you need for your recovery. First, the workers’ compensation insurance company may have an administrative appeals process that allows you to challenge the insurer’s determination. In an administrative appeal, you can provide the insurance company with additional information to correct its findings and bolster your claim.
If the insurer issues a final denial of your claim, you can still pursue a formal appeal by filing a notice of claim with the Georgia State Board of Workers’ Compensation. You should also forward a copy of your notice of claim to your employer and its insurer. By filing a notice of claim, you can request a formal hearing before the State Board to receive an official decision on your workers’ comp claim. During the formal hearing process, you and your employer can pursue mediation to resolve the dispute over your benefits, either by having your employer agree to provide benefits or negotiating a settlement of your claim.
The State Board will schedule a hearing on your workers’ comp claim with an administrative law judge. The hearing operates like a trial. You and your employer will present your respective evidence, witness testimony, and arguments to convince the judge to rule in your favor. After hearing and considering the evidence, the judge will either issue a decision affirming the denial of your workers’ comp claim or rule in your favor and order your employer to provide benefits.
Even if the judge rules against you, you still have the right to file an appeal. First, you can appeal the judge’s decision to the State Board’s Appellate Division. The Appellate Division will assign a panel of three State Board members to consider your appeal. Appeals typically occur via written brief, although either party can request oral argument before the panel. Following written and oral arguments, the Appellate Division will consider the evidence and the parties’ arguments and issue a decision.
If the Appellate Division also rules against your workers’ compensation claim, you may further appeal to the Georgia state courts by filing a lawsuit and following the court litigation process. A Georgia workers’ comp attorney can guide you through every stage of the appeal process and ensure your paperwork is filed correctly and on time.
Additional Workers’ Compensation Questions
The Georgia workers’ compensation system can be confusing and intimidating to navigate, especially when you’re already dealing with the challenges arising from your workplace injury. Here are answers to some common questions injured employees have about the system.
Are Workers’ Compensation Benefits Taxable?
Georgia tax laws and the federal Internal Revenue Code do not tax workers’ compensation benefits like medical benefits or wage loss payments. You should not receive a W-2 or 1099 for your workers’ compensation benefits because they do not qualify as taxable income. However, if you return to part-time or light-duty work, any wages you receive while performing that work constitute taxable income. State and federal laws also do not tax lump-sum workers’ compensation settlements or workers’ compensation death benefits paid to surviving dependents of a worker who passes away from work-related injuries.
How Long Can You Receive Workers’ Compensation Benefits in Georgia?
Injured Georgia workers can receive medical benefits until they reach maximum medical improvement. Workers temporarily unable to work due to their injuries can receive wage loss benefits for up to 400 weeks or until they can return to work in some capacity. However, when workers must return to a lower-paying modified-duty role, they can receive temporary partial disability benefits for up to 350 weeks.
When a worker develops a permanent disability after exhausting their wage loss benefits or reaching maximum medical improvement, they can file a claim for permanent partial disability benefits. The duration of these benefits depends on the nature and severity of the worker’s disability. However, if workers become permanently disabled from any form of work, they may request permanent disability benefits.
Do I Have to Pay Back a Workers’ Comp Lien If I Get a Third-Party Settlement for the Same Injuries?
Under Georgia law, a worker who gets hurt at work due to a third party’s negligence (i.e., the fault of a party unaffiliated with the worker’s employer) can file a personal injury claim against that third party. However, the law also gives the worker’s employer or its insurer the right to file a subrogation lien against the worker’s personal injury claim. This entitles them to reimbursement of workers’ compensation benefits paid to the worker for an injury caused by the third party if the worker obtains complete compensation through their personal injury claim.
Can You Work a Second Job While Getting Workers’ Compensation?
You may work a second job in Georgia while receiving workers’ compensation benefits under certain circumstances. However, doing so can jeopardize your eligibility for workers’ comp benefits. In most cases, you can continue to work a second job while receiving workers’ compensation from another job where you suffered injuries if you had that second job before getting injured, and as long as working that second job does not violate the medical restrictions that prevent you from working your first job. Taking a new job while on workers’ comp for a first job may cause your employer or its insurer to question the validity of your injuries or disability.
Additionally, suppose you continue working in a second job with similar duties to your first job. In that case, your employer or its workers’ compensation insurer may deem you capable of returning to work and may terminate your workers’ comp benefits. Furthermore, workers’ comp will only provide lost wage benefits to the extent you miss wages from the job in which you got hurt. Workers who can replace that lost income by increasing hours worked in a second job may have their wage loss benefits offset by their increased income from their second job.
What If I Was Working a Second Job When I Was Injured?
When you get hurt while working a second job, your employer is responsible for providing you with workers’ compensation benefits, including medical benefits and wage loss benefits. Suppose your injuries in that second job also prevent you from working in your primary job. In that case, your second employer’s obligation to provide workers’ comp benefits includes providing wage loss benefits for your total lost income, including the income you would have earned in your primary job.
Can You Sue Your Co-Worker in Civil Court?
You typically cannot sue a co-worker whose negligence causes your work-related injuries, as the exclusive remedy rule that bars you from filing a personal injury claim against your employer also applies to your co-workers. However, this only applies if your co-worker’s negligent acts that injured you occurred in the course of their employment. When a co-worker commits a negligent or reckless act unrelated to their job duties – such as engaging in pranks or horseplay – and that act injures you, you may have a personal injury claim against your co-worker.
What Happens If I’m Hurt on My Lunch Break?
In Georgia, workers’ compensation typically does not provide coverage for injuries that occur during an employee’s lunch break, as the law considers such breaks part of the employee’s personal time. Many employers require workers to clock out for scheduled meal breaks, which means that any injuries during a meal break do not occur “on duty.” However, you might have the right to claim workers’ comp benefits for injuries that occur during a lunch break under certain circumstances, such as when:
- You continue to perform your job duties while eating lunch
- Your employer requires you to attend a work-related function or seminar during lunch
- You go to lunch with a client to discuss business, and your employer considers having lunch meetings with clients a part of your job duties
You do have the right to claim workers’ compensation benefits for injuries incurred during unscheduled breaks, such as unscheduled coffee, smoke, or restroom breaks. Furthermore, you may have an injury claim if you get hurt on company property during your break when the accident occurs due to a dangerous property condition.
Can You Be Fired While on Workers’ Comp in Georgia?
At-will employees may face termination even while receiving workers’ compensation benefits. Employers may have legal grounds to terminate injured workers on workers’ comp. For example, an employer can fire an injured worker if they cannot perform their duties due to medical restrictions. Employers do not have to hold a job open for an injured worker or offer them a modified-duty role unless they take job-protected leave, such as under the Family and Medical Leave Act. However, when a worker becomes disabled due to a work injury, their employer must discuss possible reasonable accommodations to allow them to return to their usual role, such as modified work hours, extra break time, or ergonomic workstations.
Employers can also terminate workers on workers’ comp as part of a reduction in force. However, disability discrimination laws prohibit employers from using a worker’s disability or perceived disability as grounds for termination.
Finally, employers can terminate employees on workers’ comp for disciplinary reasons that arise before or after the employee’s injury. When a worker suffers an injury during disciplinary proceedings, the employer may continue those proceedings and ultimately terminate them even as they receive workers’ comp.
Employers cannot terminate employees in retaliation for filing a workers’ compensation claim or receiving benefits. Workers’ compensation retaliation may occur when the employee’s request or receipt of benefits factors into the employer’s decision to terminate the worker.
However, an employer who terminates an employee on workers’ comp must continue to provide those benefits to the employee. Medical benefits can continue until the employee reaches maximum medical improvement. The employee can also continue to receive wage loss benefits as long as they remain disabled and cannot earn the same income level as before their injury.
Get Help from Our Savannah Workers’ Compensation Lawyer
If you’ve suffered injuries in an accident at work, you deserve to receive workers’ compensation benefits that can help you obtain medical treatment and rehabilitation and replace your lost wages. Hiring a Georgia workers’ compensation lawyer from Parsons Law Group can help you secure the compensation you need if your employer or insurers delay or deny your benefits claim. Contact our firm today for a free, no-obligation consultation with a Georgia workers’ compensation attorney to discuss your legal rights to recover benefits and financial compensation after a workplace accident.
