Georgia’s workers’ compensation system is very different from many other areas of law you may be more familiar with through experience or popular culture. It has its own methods and eccentricities, and most folks aren’t aware of what they should do in the event of a work injury. In this blog, my goal is to explain, in a broad sense, what workers’ compensation may be able to do for you. You should consult with your attorney and their team to discuss the specifics of your situation.
Workers’ compensation can pay for three basic categories of benefits. It can pay your approved medical expenses, directly to the providers. While your Authorized Treating Physician is holding you out of work, or if your employer cannot accommodate your Light Duty restrictions, workers’ comp can pay you two-thirds of your Average Weekly Wage. This is calculated by averaging your weekly pay for the 13 weeks prior to your injury. This payment can end when a) your doctor puts you back into work, b) your job starts accommodating your restrictions, or c) you quit your job or are fired for cause. Finally, if and when your Authorized Treating Physician determines you have reached Maximum Medical Improvement, workers’ compensation can pay you a Permanent Partial Disability award, if applicable. This could be either in a lump sum or via a number of weekly checks.
If you suffer a work injury, you MUST report it to a supervisor within 30 days, but the sooner the better. This is best done contemporaneously with your injury, but at times that is not possible or practical. In any event, you must report it within 30 days or risk forfeiting your claim to benefits entirely. However, there are a few things you should know before making a report.
A crucial error that many workers’ compensation claimants make is not telling their employer or medical providers that they suffered their injury at work. Many claimants may say something like “well, I may have hurt it picking up my kids” or “I don’t know how I hurt it.” This can put you in a much worse position regarding your claim. It can be extremely difficult to backtrack on such a statement, and this may result in your claim being denied and requiring time-consuming litigation to get you the benefits you deserve.
HR representatives and insurance adjusters know exactly what to say to get you to second-guess yourself or cast doubt on the cause of your injury. They can easily twist your words to muddy the waters around your claim, and they do not have your best interests at heart. You must be firm and clear that you were hurt in the course and scope of your employment, and don’t allow any wiggle room or shadow of a doubt. You should consult with your attorney prior to giving any statement to your employer beyond your initial report of injury, and certainly before ANY statement to an insurance company or adjuster.
Making your report of injury to your work supervisor initiates the first phase of your workers’ compensation case: treatment. During this time, you will see a doctor that you select off a form called the Panel of Physicians. Consult with your workers’ comp lawyer prior to selecting a Panel physician, as this choice has far-reaching consequences for your claim. Whatever you do, do NOT select an urgent care or similar facility. They have their place in emergencies but are not equipped to supervise the long-term care your work injury may require.
Your Authorized Treating Physician has more influence on the direction of your case, at least on the medical side, than any other individual. They are the ones who diagnose your injury, relate it to your work activity, prescribe treatment, refer you for any additional care, and determine your ability to work and any restrictions on your doing so. There are ways to get additional opinions, but your workers’ comp insurer isn’t bound to listen to anyone besides your Authorized Treating Physician. That is why it is critical that you consult with your attorney before making this decision.
The treatment phase of your claim continues until either the Authorized Treating Physician releases you to work without restriction, places you at Maximum Medical Improvement, or you decide to pursue settlement of your claim. There are other ways that your treatment may end, and you should discuss these with your attorney. During the treatment phase of an approved claim, the workers’ compensation insurer will pay your medical providers directly for your care.
In the event your claim is denied for any reason, your lawyer may need to file a hearing in your case. This begins the litigation process, which can take a great deal of time to resolve. First, your attorney and those of the insurer will engage in what is known as the discovery process. This may include written questions, depositions of yourself and other key witnesses and experts, and the providing of any evidence such as surveillance footage, medical bills, or even social media posts in the form of exhibits. This process continues until the hearing itself, where a judge will rule on the specific issues set forth in your hearing request.
Throughout the life of your workers’ compensation claim, and especially during the discovery phase, it is not uncommon for insurers to place injured workers like yourself under surveillance. This might mean that they hire private investigators to track your movements and activities, or it could simply mean that they monitor your social media accounts and posts. Many cases have unraveled due to an unguarded social media post. The internet is forever, and any words, pictures, or videos you post online could have major ramifications on your workers’ compensation claim. The best policy for social media during the life of your claim is radio silence. You should consult with your attorney to learn how best to protect yourself and your rights during the course of your workers’ comp claim.
It’s important to note that judges in workers’ compensation claims do NOT outright decide cases like a judge or jury may do in a personal injury claim or criminal case. Rather, judges in workers’ compensation claims decide specific issues that may or may not decide the ultimate outcome of your case. Issues such as whether your case should be accepted, whether a certain prescribed treatment should be approved, and whether or not you are eligible for income benefits are all issues a judge could decide at a hearing. There are other hearing issues as well, and you should consult with your workers’ comp lawyer to see which, if any, apply to your claim.
It is possible, though not mandatory, that your workers’ compensation claim may result in a settlement agreement regardless of whether it is an accepted or denied claim. This is an optional process, and neither side can ever be compelled to settle by a judge. Your attorney will work with you in evaluating your claim and seeking the best resolution for you and your family. Settling your claim ends the workers’ comp process and can have an impact on your employment status with your current employer. This also means that your medical and income benefits through workers’ compensation will end, and you will be responsible for any future medical treatment. Speak with your attorney about what a settlement could mean for you.
Workers’ compensation can be a confusing area of the law: it differs greatly from many other aspects of law, and a small mistake early in your claim can have far-reaching, even permanent, effects on your claim. If you have a work injury, do not wait! Contact The Eichholz Law Firm and see what we can do to get you all the benefits to which you are entitled.