Medical care issues
Disability benefits
Return to work issues
General questions
Can I go to my own doctor or do I get a choice of doctors?
Georgia employers are supposed to have a panel of six doctors posted and one of them must be an orthopedic surgeon. You select a doctor and he or she becomes the authorized treating physician and provides treatment at the employer’s expense. If you see your own doctor, without authorization from the employer or their insurance carrier, they usually do not have to pay for the treatment. In an emergency situation prior authorization generally will not be required however.
If I don’t like the doctor I’m seeing, can I get a second opinion?
In Georgia, if the insurance company will not agree to a second opinion, the only other option is an independent medical examination. You are entitled to one such exam at their expense within 120 days of receiving any disability benefits. You may always seek a second opinion at your own expense, of course.
Why does it take so long to get procedures and appointments authorized? This is probably the most frustrating aspect of the workers’ compensation system for the doctors and for the injured employee. In Georgia, once an authorized treating physician is selected, the insurance company is supposed to pay for all reasonable treatment, but the doctors generally want to get authorization from the adjuster before scheduling appointments, tests, therapy, surgery, and so forth so they can be assured that they will be paid.
What do I do if my employer won’t pay my medical bills that are incurred as a result of the on-the-job injury?
First, make sure that the bills have been properly submitted to the workers’ compensation insurance company. Insurance companies will not pay until they have documentation as to what the bill was for, that it was related to your work injury, and that it was either authorized or due to an emergency. Do not allow the employer or a medical provider to submit bills to your group health insurance provider. Most group plans (such as Blue Cross Blue Shield, for example) contain an exclusion for work related medical expenses. If the workers’ compensation carrier will not pay valid authorized or emergency medical expenses, we have to file a motion with the Georgia State Board of Worker’s Compensation and try to get an order compelling payment.
How much do I get for mileage for medical treatment?
In Georgia cases, the reimbursement rate is $.40 per mile for all travel to any authorized medical provider, including going to the pharmacy, regardless of location.
What happens to my medical care once I settle the case?
In Georgia, there is no law prohibiting settlement of future medical care, and generally insurance companies will not settle cases unless you agree to close future medical, so this is usually not an issue. However, if your settlement includes a Medicare Set-Aside (MSA) account, you will have funds available for payment of medical expenses without having to get authorization from any insurance company. Use of such accounts is limited to payment for work related treatment that would otherwise be covered by Medicare, so the funds must be handled carefully. See below.
What is a Medicare Set-Aside or MSA account?
If you are eligible for Medicare benefits, or will become eligible for Medicare within 30 months, settlement of future medical care becomes much more complicated. Medicare does not want employers or workers compensation insurance companies to dump their obligations for future medical expenses onto the Federal government. So, if settlement of future medical care is proposed and you are eligible for Medicare, a certain amount of the settlement money must be “set-aside” in a separate account to be used only for those medical expenses that would otherwise be paid by the workers’ compensation insurer. The account is called a Medicare Set-Aside account and is commonly referred to as a MSA. Only after the MSA funds have been properly spent on medical care will Medicare assume any responsibility for payment of your work related medical expenses. The MSA is designed to protect your right to Medicare benefits, and to protect the employer and insurer from being sued by Medicare for not paying for your future medical care.
What if I have problems obtaining medical care after the case is settled?
In Georgia cases, future medical care is typically not an issue since almost all cases that are settled include closure of future medical care, although some settlements include a Medicare Set-Aside (MSA) account. We can assist with advice concerning management of MSA funds, but it is your responsibility to limit use of the funds in such accounts to payment for work related treatment that would otherwise be covered by Medicare. See above.
How much will I be paid while I unable to work?
You are entitled to temporary total disability (TTD) benefits equal to two-thirds of your average weekly wage, subject to a maximum limit of $500 per week in Georgia.
When does the insurance company have to send me my check?
After an injury occurs, there is a one week waiting period before any disability benefits are due, so you get nothing for the first week off work. However, if the disability continues for at least 21 days in Georgia, the employer and their insurance carrier have to pay the first week’s benefits retroactively.
Where is my check?
This is the most frequently asked question we get! Insurance companies are notorious for not paying on time. Unfortunately, they can legally run about two weeks behind on payment. In a Georgia case, benefits are due 21 days after the employer has knowledge of the injury and benefits are to be paid weekly thereafter. Georgia law provides for an automatic 15% penalty if disability benefits are not paid when due.
Will I get my job back?
It depends. Of course, we hope that as a valuable employee with knowledge and skills, your employer will be anxious to have you back and will hold your job for you as long as possible. The workers’ compensation laws in Georgia do not require your employer to hold your job for you after an injury. However, your employer and their insurance company can frequently save money on the claim by putting you back to work when you are released by your doctor, which gives them some financial incentive to try to get you back to work. In Georgia, temporary benefits can continue for nearly eight years (400 weeks) if the employer does not put you back to work, so finding a job for you can save their insurance company a lot of money. And, the Federal Family & Medical Leave Act (FMLA) may apply in certain situations, and require the employer to restore you to your former position, or an equivalent position.
Can I still collect benefits if my doctor releases me to light duty?
If you are released to return to work with certain restrictions (light duty), generally your employer has the option of offering a job within those restrictions or continuing to pay disability benefits. If you have to return to work at a job that pays less money, you may be eligible for temporary partial disability (TPD) benefits to make up for some of the difference between what you were earning before and what you are now earning on the light duty job. And, benefits for permanent disability may be awarded even after you return to work, if you have permanent impairment.
How much will I be paid if I perform light duty?
That is up to the employer, and it may be less that what you were earning before the injury. But, you may be eligible for temporary partial disability (TPD) benefits as described above.
What do I do if I am offered FMLA?
Fill out the papers and take it. Be sure the request for leave is for the same serious health condition as your injury.
Can I be fired for making a workers’ compensation claim?
You can be fired at will in Georgia, except for reasons prohibited under state or Federal law, such as race, color, sex, national origin, age or disability. An employer can almost always find a pretense for firing an employee, such as being late for work or for violating a safety rule, etc. However, there are financial incentives that usually discourage responsible employers from firing employees after an injury on the job, as discussed above.
Can I obtain unemployment benefits after being injured on-the-job? Generally you cannot collect both unemployment benefits and disability benefits under workers’ compensation. You must be ready, willing and able to work to qualify for unemployment benefits. If there is a dispute over your injury on the job, or if the workers’ compensation benefits are delayed for some reason, and you are able to do light duty work, you can apply for unemployment benefits to help you get by, as long as you are careful to state on the application that you are willing to work within your restrictions.
Can I collect Social Security disability benefits (SSDI) for a work injury?
If the injury is serious enough to cause disability lasting at least 12 months, you may be able to obtain Social Security disability benefits (SSDI). Social Security pays approximately 80% of your pre-disability average income. Workers’ compensation benefits are typically only two-thirds of your average income. However, Social Security takes a credit or offset for the worker’s compensation benefits, so you can not obtain a combined benefit from Social Security and workers' compensation in excess of 80% of your pre-disability income. Qualifying for SSDI also makes you eligible for Medicare. We generally advise our clients to apply for SSDI in serious injury cases, and then if the claim is denied, we can file an appeal for you.
If we go to court, will I have to testify in front of a jury?
No. In Georgia workers’ compensation cases are tried before a special judge (ALJ) who only hears workers’ compensation cases.
Can the insurance company be held accountable for taking forever on my checks, prescriptions and procedures?
If it becomes necessary to file a motion or request a hearing to enforce payment or authorization, we can seek penalties and/or an award of attorneys’ fees against the insurer for unreasonable delay or refusal to pay, or to authorize treatment.
Can I sue my employer for pain and suffering?
No. Workers’ compensation is a no-fault system that provides benefits regardless of who caused the injury. Accidents on the job happen for many reasons. Sometimes a co-worker is careless, sometimes the employer furnishes defective equipment or working conditions are unsafe, and sometimes the injured person makes a mistake. Even if you are careless, cause an accident and hurt yourself, you still get workers’ compensation benefits. The trade-off for such a system is that you cannot sue your employer for anything other than workers’ compensation benefits even if the injury was your employers’ fault. If the injury was due to the fault of someone other than you, a co-worker or your employer, however, you may be able to sue for pain and suffering. For instance, if you are in a wreck out on the highway and it was not your fault, you can collect workers’ compensation benefits and still sue the "at fault" driver for pain and suffering and other damages.
If I settle, how long until I get my money?
In Georgia, after the settlement papers are prepared, they have to go to the State Board of Workers’ Compensation for approval, and that usually takes a week or two. Georgia law requires the settlement funds to be paid within 20 days after approval by the Board. |
