I developed a sickness from my job. Is this covered by workers' comp?

Potentially. Georgia law provides that an "occupational disease" is compensable so long as certain statutory requirements are satisfied. Specifically, O.C.G.A. § 34-9-280 states that an "occupational disease" means "those diseases which arise out of and in the course of the particular trade, occupation, process, or employment in which the employee is exposed to such disease." In addition, five requirements must be met: 

1. There must be a direct causal connection between the conditions under which the work is performed and the disease;
2. The disease followed as a natural incident of exposure by reason of the employment;
3. The disease is not of a character to which the employee may have had substantial exposure outside of the employment;
4. The disease is not an ordinary disease of life to which the general public is exposed; and
5. The disease must appear to have had its origin in a risk connected with the employment and to have flowed from that source as a natural consequence.

Because of these strict statutory requirements, it can be difficult to prove an occupational disease claim. If you feel that you've developed an illness because of your job, you should contact an attorney right away to discuss your options. Even if you're not in the Athens, Georgia area, feel free to contact us and we will be glad to assist you with your claim.

If I'm receiving unemployment benefits, how will that affect my workers' comp claim?

Any unemployment benefits received while you are entitled to either TTD or TPD benefits will be deducted from your workers' comp benefits (note that a credit cannot be taken by the Employer against any PPD benefits).  In other words, injured workers are not entitled to a "windfall" or a double award of weekly benefits.

For example, if your compensation rate is $400.00 per week, and you are also receiving $300.00 per week in unemployment benefits, you would only be entitled to receive $100.00 per week in workers' comp benefits.

Quick Definitions: Administrative Law Judge

The Administrative Law Judge, or ALJ, is the judge that is assigned to preside over a workers' compensation case through the initial hearing. Prior to the hearing, the ALJ makes decisions on any motions filed by the parties and has the authority to schedule or continue the hearing, among other things. At the hearing, the ALJ hears and receives all evidence from both parties and issues a written decision determining the outcome of the case.

I was working two jobs when I got hurt. Does this affect the amount I receive in weekly benefits?

It depends. Whether a second job affects your compensation rate (how much money you receive in weekly benefits) depends on a couple of things. First, were you employed by the two jobs at the same time? If not, then any wages you earned at the second job will not be taken into account when determining your compensation rate.

However, if you were employed concurrently at the two jobs, such as in the question asked in the topic of this post, the question then becomes whether the two jobs were substantially similar in the eyes of the Administrative Law Judge at the hearing. If the two jobs were so similar in nature with respect to job description, duties, and/or physical requirements, then the wages you earned at the second job will be taken into account when your compensation rate is calculated. If the jobs were different, then your compensation rate is calculated only using the wages you earned at the job where you were injured. This doctrine, known as "concurrent similar employment," is often an issue that is contested by the parties to a workers' compensation claim due to the factually-specific nature of the various job descriptions and duties.

A couple of examples might help clear this up:

1. John is employed during the day on an assembly line at Company A. At night, he works on the assembly line at Company B. If he was injured on the job at Company A and was forced to miss work at both jobs, the wages for both jobs would be used to calculate his weekly benefit.
2. John works on the assembly line at Company A during the day. At night, however, he works in a non-physical supervisory job at Company B. If he was injured at Company A, his wages from Company B would not be used to calculate his weekly benefit. Moreover, he could continue working his job at Company B without it affecting his receipt of weekly benefits from Company A.

As you might imagine, there are many different facts that can potentially affect how your compensation rate is calculated and when it can be altered or suspended. If you were working multiple jobs at the time of a work accident, it would be prudent to contact a workers' compensation attorney to ensure that your weekly benefits are being properly calculated. Even if you're not in the Athens, Georgia area, we will gladly assist you in any way we can with respect to your workers' compensation case.

Quick Definitions: Panel of Physicians

The Panel of Physicians is a list of doctors and care providers which must be maintained and posted by the Employer in the event that a worker gets injured on the job. After an injury, a worker must treat with one of the physicians on the panel. In Georgia, there are three kinds of panels that may be utilized by an Employer: Traditional, Conformed, or MCO. 

For more information on the Panel of Physicians, please look here. 

Did You Know? (Termination From Employment Edition)

Did you know that if your Employer terminates you from your job because of your work injury, you are automatically entitled to the commencement of TTD benefits?

The question of whether the termination was actually due to the work injury is often a blurry one, because Employers will usually not document that the injury was the reason for the termination. Moreover, it is highly unlikely that an Employer will automatically begin paying workers' comp benefits to an employee they just terminated. 

Tip: If you have sustained a work accident and were later fired, it is highly advisable to contact an attorney to advocate for your rights. Even if the termination from employment was a part of a general lay-off (and was not related to the work injury), you may be entitled to receive TTD benefits if you are unable to find new employment because of your physical restrictions.

I injured my back at work and began receiving benefits. The next month, I injured my back again when I was playing basketball at home. Can the Employer suspend my benefits?

This is a very tricky question and there isn't a very clear cut answer. Chances are, you will be able to continue receiving workers' comp benefits for your back. However, the Employer will likely put up a pretty big fight against it.

Georgia law addresses what are commonly referred to as "independent intervening injuries" in O.C.G.A. 34-9-204(a), which states "No compensation shall be payable for the death or disability of an employee if his or her death is caused by or, insofar as his or her disability, may be aggravated, caused, or continued by a subsequent nonwork related injury which breaks the chain of causation between the compensable injury and the employee's disability."

The case law dealing with this issue in Georgia has been somewhat back and forth, but it appears as though the common theme is that Claimants who are actively receiving benefits/ongoing treatment for the initial work injury will be able to continue receiving the benefits, even if they are subsequently injured in a non-work accident (even if the Claimant was being careless or negligent). However, if a Claimant had been deemed to have fully recovered by his ATP and at some later point re-injures the same body part that was initially injured at work, a reinstatement of benefits would be denied.

Tip: It should be noted that the law requires the Employer to prove that the "chain of causation" has been broken, as opposed to simply unilaterally suspending benefits. In other words, in the example question used in the title of this post, the Employer would have to request an official hearing and have a judge rule on the matter before suspending benefits. If your Employer has cut your benefits off based on this contention, you should absolutely contact an attorney to discuss your options.

Again, this is a highly complicated area of workers' compensation law, so it is always best to consult with an attorney to determine how best to proceed. Even if you're not in the Athens, Georgia area, please contact us and we will do everything we can to fight for your rights.

Quick Definitions: Compensable Injury

This term is used to describe worker's compensation injuries and basically means "covered by workers' compensation insurance." A compensable injury is one that arose "out of and in the course of the Claimant's employment" and for which a Claimant can receive medical care and potentially income benefits.

If I suffer a heart attack or stroke while at work, is that covered by workers' comp?

Generally, no--but there may be situations where this type of injury is compensable. Georgia law specifically provides that an injury or personal injury does not include "heart disease, heart attack, the failure or occlusion of any of the coronary blood vessels, stroke, or thrombosis unless it is shown by a preponderance of competent and credible evidence...that any of such conditions were attributable to the performance of the usual work of employment.”

The reason for the general rule against these kinds of "injuries" being compensable is the principle that, in order to be covered by workers' comp, an injury must arise both "out of and in the course of employment." Thus, a heart attack or stroke is only covered if it can be proven that the work environment or certain aspects of the job led to the "injury." This type of claim can become highly contested due to the fact that these injuries are so factually unique and can be caused by many different factors, such as job stress. 

These injuries can also lead to another complicated area of workers' compensation law--idiopathic injuries. That is, if the Claimant suffers a stroke and falls down and sustains other injuries. If you or a family member has suffered a heart attack or stroke at work, please contact us and we will do everything we can to guide you through the process.  

Quick Definitions: Idiopathic Fall

The term "idiopathic fall" typically comes up as a defense asserted by the Employer.  Strictly defined, idiopathic means "of unknown cause or origin." Thus, an idiopathic fall is a fall caused by an unknown source. Essentially, when this defense to a workers' comp claim is used by an Employer, they are saying that the reason that the Claimant fell down was due to a reason that had absolutely nothing to do with the Claimant's employment, such as an epileptic seizure. An idiopathic fall defense is extremely complicated and very factually dependent, so if your Employer is denying benefits based on this theory, it is highly advised that you contact an attorney to discuss your options and rights.

Quick Definitions: Independent Medical Evaluation (IME)

An Independent Medical Evaluation, or IME, is a one-time examination that can be requested by either the Employer/Insurer or the Claimant. An IME is simply a way to obtain additional evidence, or simply some evidence to support the position of either party in the workers' compensation claim. For instance, if the Claimant's authorized treating physician (ATP) gives the opinion that the Claimant's injured back is fully healed, a Claimant may want to obtain an IME to contradict the ATP's diagnosis. This evidence can come in extremely handy at a hearing or during settlement negotiations.

I disagree with my authorized physician's diagnosis. Can I get a second opinion?

If effect, yes. Under Georgia law, a Claimant is allowed to seek a second opinion with a physician of his or her choosing (in other words, it is not limited to a care provider listed on the panel of physicians) at the expense of the Employer so long as several criteria are met. This one-time second opinion is known as an Independent Medical Evaluation (IME). Again, this is a one-time evaluation--not a change in the authorized physician. Unless you seek an official change of physicians, you will continue treating with your authorized treating physician (ATP) after the IME. 

The criteria are spelled out in O.C.G.A. 34-9-202(e):

1. The injury at issue must be an "accepted compensable injury." Basically, this means that the Employer must not be disputing that the injury is covered by workers' compensation coverage.
2. The examination is being sought within 120 days of the receipt of any income benefits (either TTD, TPD, or PPD benefits).
3. The examination must take place at a reasonable time and place, within Georgia or within 50 miles of the Claimant's residence.
4. The examination must be performed by a duly qualified physician or surgeon.
5. The Claimant must give advance notice, in writing, to the Employer of the examination.
6. The examination cannot repeat any diagnostic procedures that have already been performed on the Claimant since the injury, unless the costs of the procedures which are in excess of $250.00 are paid for by a party other than the Employer or Insurer.

An IME can be an extremely valuable tool for a Claimant when negotiating a settlement. Because a Claimant only has the ability to obtain one IME, it is imperative that great care be taken when choosing the IME physician. If you are dissatisfied with the care you are receiving from your treating physician, please contact us to discuss your options.

I was injured at work because of my co-worker's negligence. Can I sue my co-worker or my employer?

In most all situations, the answer to this question is no. Georgia law provides that employers, the employer's alter egos, and an injured worker's coworkers are all immune from tort liability in the event of a workplace injury. This is known as the "Exclusive Remedy" provision of Georgia workers' compensation law. That is, when a worker is injured on the job, his "exclusive remedy" is to pursue a workers' compensation claim. 

It should be noted that nothing in the law precludes an injured worker from pursuing a tort claim against a third party who caused the injury. A common example of this is when a company driver is involved in a car accident that was the fault of the third party. In such a case, the injured worker can receive workers' comp benefits and pursue a personal injury claim against the at-fault driver (so long as this person is not a coworker or otherwise affiliated with the employer).

My back was bothering me before my work accident, but now it's really hurting. Can the employer deny benefits because of the pre-existing condition?

The aggravation of a pre-existing injury IS compensable under Georgia workers' compensation laws. As stated by the Georgia Supreme Court way back in 1940, "Fortunately for the employee, perfect health is not a prerequisite to the enjoyment of the benefits of this statute. There is no standard of health set up or provided in this statute." This rule has since been officially codified in Georgia law under O.C.G.A. ' 34-9-1(4).

Basically, every employer has to "take the employee as it finds him (or her)" and accept the fact that there may be a hidden or pre-existing health condition that could be aggravated by a work accident. Even if a "normal" person wouldn't have been injured by a certain accident, the employer is still responsible for paying medical and indemnity benefits for the injuries arising from the accident.

However, it is important to note that employers will often try to obtain an opinion from the ATP that the employee has "returned to pre-injury status" and that the "aggravation period" of the underlying injury has ended, which would then allow the employer to terminate benefits. In such a case, it is highly advised that the employee should consult with an attorney to defend against an untimely or unjust termination of benefits.

I was injured in my employer's parking lot as I was leaving work. Is this injury covered by workers' comp?

Most likely, yes. Typically, if you're injured in your employer's parking lot, whether you're coming to or leaving work, the injury is compensable under Georgia workers' comp. The language used to determine whether the injury is covered by workers' comp is "reasonable ingress/egress." That is, so long as the employee was was injured during a "reasonable" period of time while coming to or leaving work, it should be covered. The word "reasonable" obviously leaves some room for interpretation, so this is an issue that often gets disputed by employers. Another reason why an employer may controvert such an injury is if the parking lot itself is not under the control or maintenance of of employer. However, as stated above, this kind of injury is almost always compensable, so if your employer tries to deny benefits after you've been injured in their parking lot, you should immediately consult with an attorney to explore your options on how best to proceed.

Quick Definitions: "Catastrophic Injury"

Typically, a cap is placed on an injured worker's receipt of TTD benefits (unlike medical benefits, which are always the responsibility of the employer so long as it relates to the work injury). However, in the event of a "catastrophic injury," the 400 week cap is removed and the injured worker is entitled to TTD benefits for the rest of his or her life. Under Georgia law, there are 5 defined categories of catastrophic injuries--spinal cord, brain, serious burns, amputations, and blindness--and one "catch all" provision, which is factually specific and requires close examination of the true severity of the injury. In short, with regard to the "catch all" provision, if an injured worker is entitled to receive Social Security Disability benefits, he or she may (but not necessarily) be entitled to a "catastrophic" designation.

My doctor gave me two impairment ratings for the same body part. Which one applies?

It is not uncommon for an ATP to assign two separate PPD ratings pertaining to the same body part. For example, if you injured your shoulder, you physician may assign a 15% impairment rating to your shoulder and a corresponding 7% impairment rating to the "whole body." In situations like this, the rating which yields the highest number of weeks of payable benefits is the applicable impairment rating.  This is an extremely important thing to remember when discussing a potential settlement of your claim.

In this example, the 15% shoulder rating would be used to calculate the number of weeks that PPD benefits are payable, because it yields 33.75 weeks of benefits, compared to 21 weeks for the 7% "whole body" rating. As you can see, this would make a huge difference in the total amount of PPD benefits you receive! For more information on how PPD benefits are calculated, please look here.

It's important to note that this post only pertains to those situations where the impairment ratings relate to the same body part. In other words, the rules are different if you suffer an injured leg and an injured arm in the same work accident, and your doctor assigns separate ratings for each of those body parts.

Did You Know? (Surveillance Edition)

Did you know that the insurance company of your empoyer can hire a surveillance company to follow you around to try to obtain footage of you acting in a way that might undermine your workers' compensation claim? I'm not posting this to scare anybody, but it's an important thing to be aware of if you're involved in workers' compensation litigation. Seems pretty sneaky, but it's legal.

Now, it's one thing if the surveillance company catches you lifting heavy weights for an hour at the gym--but from my experience, surveillance footage is usually from a distance and only captures the target for very brief periods of time. Accordingly, it can be taken completely out of context and not be an accurate depiction of how you really feel at any given moment. This is precisely why you need to make sure that your interests are represented if the employer tries to use surveillance footage against you, whether it's at trial or during settlement negotiations. Having an experienced workers' compensation attorney on your side can make all the difference in these types of situations. If you have any questions about your claim, even if you're not in the Athens, Georgia area, give us a call and we'll do everything we can to help you.

Quick Definitions: "MMI"

This stands for maximum medical improvement. This status is typically assigned to you by your ATP towards the end of your treatment. Essentially, this means that your doctor feels that you are as good as you'll ever be with respect to your work injury, and that your recovery has reached its peak.

Do I get compensated for pain/suffering/disruption of lifestyle in the workers' comp system?

Unfortunately, workers' compensation law does not provide any sort of remedy for pain and suffering associated with your work injury. Workers' compensation law does not provide any monetary relief for the general disruption of your lifestyle and the aggravation or inconvenience which was caused by your work injury. This is obviously a very difficult reality to face, because oftentimes the financial remedies that are provided by the law don't come close to compensating you for the difficulties faced after a life-changing injury.

If you've sustained a work injury, there are only three kinds of relief that can be provided in a workers' compensation context: (1) lost wages (TTD or TPD benefits); (2) permanent impairment of physical capabilities (PPD benefits); and (3) medical care.

If you have any questions about your workers' compensation case, please let me know. Even if you're not in the Athens, Georgia area, we will gladly do everything we can to assist you with your claim.

Quick Definitions: "Impairment Rating"

Also sometimes called a "PPD rating," this is the percentage of impairment that the ATP assigns to the specific body part that was injured in a work accident, or to the body as a whole. It is usually assigned towards the end of your treatment. This rating, which must be based upon the American Medical Association's Guides to the Evaluation of Permanent Impairment (5th Edition), is used to calculate your entitlement to PPD benefits.

Quick Definitions: "PPD Benefits"

PPD is the abbreviation for Permanent Partial Disability.  This is one of three types of weekly benefits that may be payable after a work accident.  PPD benefits are designed to compensate the injured worker for the permanent physical impairment sustained to a particular body part or the body as a whole as a result of a work injury. They are based upon a percentage of impairment, or impairment rating, that your ATP assigns to your injury.

For more information on PPD benefits, please look here. To compare to the other two types of weekly benefits, TTD and TPD, please look here, here and here.

I think my weekly benefit check is more than it should be. Should I speak up?

Unfortunately, and as hard as it is to voluntarily give up income in a time when you're struggling to make ends meet because of your injury, the answer is yes.  According to Georgia workers' compensation law, employer/insurer's are allowed to recoup or recover benefits that were overpaid to an injured worker (fortunately, there are restrictions placed on how far back in time the recovery can reach). If the worker is currently receiving a weekly income benefit or if he or she is entitled to benefits in the future, the employer/insurer can take a credit against those benefits.

The amount of the credit taken against ongoing income benefits is usually worked out between the employer/insurer and the worker (or his or her attorney). For example, if you're currently supposed to be receiving $400.00 per week in TTD benefits, but you were previously paid at an erroneous higher rate which resulted in an overpayment of $2,000.00, an arrangement could be reached whereby you would only receive $350.00 per week until the employer/insurer recovered the full amount of the overpayment.

Even if you aren't entitled to any additional benefits and you don't even work for the employer anymore, a garnishment action can be commenced against you at your current place of employment. Needless to say, this will create an enormous inconvenience and burden on you as you try to move on with your life.

Fair or not, that's the way the law works. The problem is, the vast majority of workers have no idea how workers' compensation benefits are calculated, and they therefore would have no reason to suspect that their employer has made an error in the calculation. Why should an injured worker be punished down the line for innocently receiving an overpayment that was the result of the insurance adjuster's mistake? Moreover, there are many times when the miscalculation in your compensation rate is so small that you'd never have reason to suspect there was an overpayment.

This is precisely the reason why I'm writing this post--to provide basic information for workers to help avoid this potential inconvenience.  So, if you have any reason to believe that you're receiving more than you should--such as, you were a part-time employee and your weekly benefit is nearly identical to the paycheck you received prior to your injury--it is a good idea to go ahead and report it to your employer. Chances are, the employer will soon uncover the miscalculation and they will, without a doubt, come after you to recover the money. A little honesty in the beginning can save you from a big headache later on.

Also, it's worth noting that these issues can get really complicated and messy, so it's a very good idea to have an attorney on your side to help ensure that your best interests are fully represented. If you have any questions about your workers' comp case, please let me know. Even if you're not in the Athens, Georgia area, give us a call and we will gladly help you with your case.

Quick Definitions: "Compensation Rate"

An injured worker's "compensation rate" is the amount of money which is payable to an injured worker on a weekly basis for either TTD, TPD or PPD benefits. It is derived from the worker's average weekly wage ("AWW").

For TTD and PPD benefits, the compensation rate is calculated by taking 2/3 of the AWW.

For TPD benefits, the compensation rate is calculated by comparing the AWW of the injured worker prior to the accident to the AWW after the accident. The precise compensation rate is determined by taking 2/3 of the difference between the two AWW's. Thus, if the pre-accident AWW was $400.00, and the post-accident AWW was $300.00, then the compensation rate would be 2/3 of $100.00, or $66.67 (this amount would be paid by the insurer in addition to the worker's regular paycheck).

Quick Definitions: "TPD Benefits"

"TPD" is short for Temporary Partial Disability. This is a type of weekly income benefit that may be payable after a work accident. It is "temporary" because there's a cap on the number of weeks that these benefits can be received by the injured worker, and it's "partial" because they're payable when the injured worker's ability to work a full schedule has been diminished--such as when you're only able to work 20 hours per week instead of 40. They are designed to compensate the injured worker for the partial loss of income as a result of the work injury.

For more information on this type of benefit, please look here. To compare to TTD benefits, please look here.

Overview of Permanent Partial Disability (PPD) Benefits

When are they payable?

As I discussed in a previous post, there are three types of weekly benefits that may be payable to an injured worker after a work accident.  The previous post focused on TTD and TPD benefits, which are payable if the injured worker has suffered a disability due to his or her work accident. The third type of benefit, commonly abbreviate as "PPD," is only payable after the injured worker is no longer receiving TTD or TPD benefits. In other words, if you're currently receiving either TTD or TPD benefits, you cannot also receive PPD benefits at the same time.  

What is the purpose of PPD benefits?

Before I go any further, it's important to note the different purposes the three types of benefits serve under the law. While TTD and TPD benefits are paid to injured workers to compensate them for their diminished earning capacity due to the injury (loss of income), PPD benefits compensate injured workers for (1) the entire loss of a body part; (2) the loss of the use of a body part; or (3) the impairment to the injured worker's "body as a whole."

How is the amount of PPD benefits determined for each injury?

This can get a little complicated, so I'll try to keep this brief. The amount payable for a particular injury is based upon a percentage of impairment (often called an "impairment rating" or "PPD rating") which is assigned by the authorized treating physician ("ATP") to a particular body part or the "body as a whole." To determine the percentage of impairment, the ATP is required to consult the American Medical Association's Guides to the Evaluation of Permanent Impairment. For example, if you've injured your arm, the ATP will apply his knowledge of your treatment and your current condition to the AMA Guides and determine the percentage of impairment, such as 15%.  This percentage is then matched with the number of weeks assigned to each body part by Georgia law, which ranges from 20 weeks for a toe injury to 300 weeks for a back or whole body impairment.

For our example, the law states that you could receive up to 225 weeks of PPD benefits for the impairment of an arm (if you lost the arm completely, you would receive 225 weeks of PPD benefits). For a 15% impairment rating, you would be entitled to 33.75 weeks of PPD benefits (this is 15% of 225 weeks).  One more thing--the precise dollar amount of an injured worker's weekly PPD benefit, just like TTD or TPD benefits, is determined by the worker's compensation rate.

What is the "Panel of Physicians?"

The panel of physicians is a list of medical care providers that an employer must maintain for the purpose of giving employees treatment options in the event of a work injury. This list is typically a pink-colored sheet of paper that must be posted in a “prominent place” upon the employer’s premises, such as the breakroom or next to the punch in/out clock. There are three different types of panels which may be utilized by Georgia employers, all of which must meet certain requirements in order to be deemed a “valid” panel. The following is a general outline of the basic differences in the respective panels: 

1. The “Traditional” Panel – This type of panel must have list of at least six (unless this number is not feasible in a given geographical area) unassociated medical care providers to be valid. If Doctor A and Doctor B both work in the same clinic, they are not “unassociated” for purposes of the Traditional panel. Moreover, the law does not allow for more than two “industrial clinics” to be listed on the panel, and there must be at least one orthopedist listed.
2. The “Conformed” Panel – This type of panel must have a minimum of ten unassociated medical care providers (the same definition of “unassociated” applies here). Although an employer’s utilization of a Conformed panel initially gave an injured worker different rights than the Traditional panel, the law has changed such that the only practical difference between the two panels is simply the number of care providers listed. Also, this type of panel will state “Conformed” at the top of the document serving as the panel of physicians. Thus, if the panel states that it is “Conformed” at the top of the document, but only lists six physicians, it would be deemed invalid. 
3. Managed Care Organization (MCO) – An MCO provides a much more expansive network of medical care providers than that of the Traditional and Conformed panels, and there are stricter requirements for the types of physicians that must be listed. This network of physicians is compiled by an organization with whom a self-insured employer or a workers’ compensation insurance carrier enters into a contract. Simply put, the MCO compiles a list of physicians, and then the employer or its insurer enters into a contract with the MCO which allows the employer to send its injured workers to the care providers on the list. Just like the Traditional and Conformed panels, however, the law requires that the MCO procedures be posted in a prominent place on the employer’s premises. 

It should be noted that there are requirements in addition to those mentioned above which must be adhered to by employers with respect to the panel of physicians. If any of the requirements aren’t satisfied, Georgia law states that the injured worker may then commence treatment with the doctor of his or her choosing.

If you have any questions about your workers' comp case or the panel of physicians, please let me know. Even if you're not in the Athens, Georgia area, give us a call and we will gladly help you with your case.

I was hurt at work. Can I treat with any doctor I want?

Not exactly. An injured worker must choose from one of the physicians listed on the employer’s panel of physicians (there are three kinds of panels of physicians: traditional, conformed, and MCO). Although Georgia law states that it is the injured worker’s right to choose which physician he or she would like to have designated as the authorized treating physician (ATP), this usually doesn’t happen. From my experience, it is usually the employer who chooses and sends the injured worker to one of the physicians on the panel once the injury is reported.

It’s also important to point out that if a worker is injured at a time when it is not possible to go to a panel physician (such as late at night when the clinic is closed), and the injury is serious enough to warrant immediate care, the employer will be responsible for expenses incurred as a result of the emergency care. For example, if you are injured late at night and have to go to the nearest emergency room, the employer will be responsible for the ER bill. However, this doesn’t mean that the ER physician is your ATP. At some point in the subsequent days, you will be given the option to choose a panel physician as your ATP.

Tip:  Don’t let the employer force you to treat with a doctor you don’t want to go see. It is your right to choose which physician you would like to have designated as the ATP. Having said that, if you have no preference and don’t know anything about any of the doctors, it would only serve to complicate things if you object to the physician recommended by the employer for no other reason than to assert your right to choose. In other words, don’t argue for the sake of arguing, as this could create a hostile situation between you and your employer and make your time out of work even more inconvenient than it already is. If you are dissatisfied with the care provided by your first ATP, you have the right to make a one-time change of physicians to a different doctor—but this new doctor must also be listed on the panel (unless the panel is invalid, in which case you can choose any doctor at all). You only get one chance to make a change, however, so this choice should be made very, very carefully.

Quick Definitions: "Authorized Treating Physician"

The authorized treating physician ("ATP") is an injured worker's primary doctor (usually the first doctor you go to). Every injured worker has one ATP who provides routine care and can also "arrange for any consultation, referral, and extraordinary or other specialized medical services" (like a referral to an orthopedist or neurologist). The ATP holds a lot of power over your claim, not only because he or she is providing your primary treatment and can make referrals, but also because an administrative law judge will almost always honor the ATP's opinion or decision regarding your treatment. If you're not satisfied with your treatment, however, the law does allow for a one-time change of the ATP (with certain restrictions).

Did You Know? (Lifetime Medical Care Edition)

Did you know that an injured worker is entitled to lifetime medical care as long as it relates to his or her work injury? However, this medical care can't come from just any doctor--it must come from an authorized treating physician.  Moreover, the law states that the medical care must be "reasonably required and appear likely to effect a cure, give relief, or restore the employee to suitable employment."

Tip:  Many times, an employer will try to cut an injured worker off from receiving additional care by arguing that he or she has returned to "pre-injury status"--especially if there was a pre-existing condition similar to the work injury--or that the additional care is no longer reasonable. In these situations, it's important to have an attorney to fight on your behalf to ensure that you receive proper care for your injury.

Did You Know? (TTD Benefits Edition, Part 2)

Did you know that there is a cap on the number of weeks that an injured worker may receive TTD benefits? Georgia law has placed a 400-week limit on these benefits--that's a little over 7.5 years, for those wanting to pull out a calculator--hence the name "Temporary Total Disability."

This cap is removed if an injury is declared "catastrophic," but the vast majority of workers' comp claims don't fall into the catastrophic category.

Did You Know? (Notice of Accident Edition)

Did you know that you could be denied both medical and income benefits if you fail to report your work accident within 30 days of its occurrence? There are situations where a failure to report the injury will not preclude an injured worker from recovering such benefits, but the key thing to remember is that it is very important to report your injury to your employer as soon as possible so as to avoid any future complications from the failure to do so.

Tip:  While the notice doesn't necessarily have to be in writing, and even if your supervisor tells you to work through it, it is typically a good practice to document your complaint for future reference.

Quick Definitions: "Disability"

As used in the workers' compensation context, the word "disability" means impairment or diminution of earning capacity. In other words, an injury that has caused a worker to earn less than he or she did before the work accident constitutes a "disability."

Quick Definitions: "TTD Benefits"

"TTD" is short for Temporary Total Disability. This is a type of weekly income benefit that may be payable after a work accident. These benefits are designed to compensate the injured worker for the loss of income as a result of the work accident. They are "temporary" because there's a cap on the number of weeks that these benefits can be received by the injured worker, and they're "total" because they're payable when the injured worker cannot work in any capacity.

For more information on this type of benefit, please look here or here.

Judge: Online Privacy is just "wishful thinking"

“Privacy is no longer grounded in reasonable expectations, but rather in some theoretical protocol better known as wishful thinking.”

Pretty harsh—but also pretty accurate. This is the language from the judge in a recent ruling in the New York case, Romano v. Steelcase Inc., 2010 WL 3703242 (N.Y.Sup. September 21, 2010) regarding online privacy. I found this case on Twitter through @internetcases, which is the profile of Evan Brown, an attorney in Chicago. You can read his summary of the case here.

In essence, this case addressed whether information on the Plaintiff’s Facebook and Myspace pages could be withheld during discovery, irrespective of her privacy settings. (“Discovery” is a legal term describing a period of time during which the parties use various methods to gather as many facts as possible about the case). As you can tell from the quote at the top of this post, the judge determined that all of the contents had to be turned over to the other party.

Tip:  While this isn't a Georgia case and doesn't pertain to workers' compensation, there's nonetheless an important lesson to be learned here: social media sites can affect your case in a negative way, and courts aren’t allowing people to hide harmful information. And based on this ruling, this is true even if you think you have “hidden” it from the public in your personal privacy settings, or if you have deleted certain content! (Yep, Facebook and Myspace store deleted information). So, again, be careful what you broadcast to the public, because it may very well come back to bite you.

Did You Know? (TTD Benefits Edition, Part 1)

Did you know that there is a cap/limit on the amount of TTD benefits you can receive per week? For injuries occurring on or after July 1, 2007, the maximum amount an injured worker can receive is $500.00 per week.  This maximum applies even if you're making Bill Gates' salary. For injuries occurring prior to July 1, 2007, the maximum amount is less than $500.00 and is dependent upon the date of accident (the Georgia legislature changes the maximum amount every several years).

Did you know? (Panel of Physicians Edition)

Did you know that if the "Panel of Physicians" maintained by the Employer is not valid (for example, if it does not contain up-to-date information or if it does not comply with the requirements of the Georgia statute), then an injured worker "may select any physician to render service at the expense of the employer"? (O.C.G.A. ' 34-9-201).

Tip:  If you've been injured at work, always ask to have a copy of the Panel of Physicians that was posted on the date of your accident--it may come in handy if you're not satisfied with the treatment provided by the physician chosen by the Employer.

The "All Issues" Statute of Limitations

A legal term gets thrown around at times that a lot of people might not understand—“statute of limitations.” In essence, this concept says that you only have a certain period of time during which you can file a lawsuit after the event happened which gave rise to the claim (like a work injury or a breached contract). An easy way to remember what it means is by its abbreviation: SOL. As in, once the period expires, you are “sure/simply/so out of luck.” Cough cough.

In a workers’ compensation context, if you’ve been physically injured at work, Georgia recognizes two (2) different statutes of limitation: a “change in condition” SOL and an “all issues” SOL. The “change in condition” SOL, which will be addressed in a later post, applies when a judge has actually issued a specific ruling on your condition at some time after the work accident, or if the Employer has accepted liability and is CURRENTLY paying you weekly income benefits.

However, in the situation of “I was hurt at work, I am not currently receiving weekly income benefits, how long do I have to file my claim?”, it is the “all issues” SOL that applies. Notably, even if the Employer IS providing you with medical care (but isn’t currently paying weekly income benefits), the “all issues” SOL still applies.

As outlined by Georgia law, there are three (3) measuring periods which are covered by the “all issues” SOL. The applicable measuring period depends on the set of facts in your case:

1. One year from the date of injury. Note that this is the date of “injury,” and not “accident.” Thus, this time period begins to run only after the injury manifests itself. This period applies if the Employer never pays for your medical care and never pays you weekly income benefits—basically, if they just ignore the accident.
2. One year from the last medical treatment provided by the Employer. If the Employer keeps providing (paying for) your medical treatment, the statute keeps restarting itself.
3. Two years from the Employer’s last payment of weekly income benefits. If the Employer was paying you weekly income benefits and subsequently stopped, the statute would begin to run on the last date the income benefits were paid.

Which statute of limitations applies to you and how much time you have to file a claim can be a very complicated matter. And, if the “all issues” SOL has expired, it will prevent you from being able to receive any income benefits or medical care in the future—so, needless to say, a lot is on the line. If you have any questions regarding your workers’ compensation claim, please let us know so we can assist you with the process.

Computing Average Weekly Wage

In the event that you suffer an on-the-job injury, it is important to understand both the kinds of benefits to which you are entitled, as well as how to calculate such benefits. Unfortunately, insurance adjusters will occasionally make errors in calculating the amount of benefits which are due to an injured employee, so an understanding of how your benefits are calculated can be a valuable asset if you’ve been hurt at work. This post will very briefly discuss the three (3) methods by which an injured worker’s “average weekly wage” (AWW) is computed under Georgia law.

To determine the amount due to an injured worker for either TTD or TPD benefits (please see my previous post regarding TTD and TPD benefits), the worker’s AWW must first be computed. In most situations, this figure is calculated by taking the average of the total gross wages (pre-tax) earned for the 13 weeks preceding the date of accident. What are the components of these gross wages? AWW encompasses “salary, hourly pay, tips, and the reasonable value of food, housing and other benefits furnished by the employer without charge to the employee which constitute a financial benefit to the employee and are capable of pecuniary calculation.” (Board Rule 260(a)). In other words, if an employee receives $15.00 in gas money each week, this amount will be added to his or her regular salary.

However, there are often situations in which an employee has not been working for substantially the whole of the 13 weeks prior to the injury (like if the employee was hired only 5 or 6 weeks prior to the accident). In those situations, the AWW can be computed by averaging a “similarly situated employee’s” gross wages for the 13 weeks preceding the date of accident. Ideally, a “similarly situated employee” is someone performing the same job, on the same shift, with the same wages.

If the above 2 methods cannot be used, the last method by which an AWW can be computed is by taking the full-time average weekly wage of the employee. In other words, if an employee is paid $10.00 per hour and a full-time work week is 40 hours, then the AWW would be $400.00 per week.

Tip:  Again, insurance adjusters will often make errors in calculating an employee’s AWW and will not take into full account all of the potential components of the employee’s gross wages. For this reason, it is important to have an attorney on your side to help you maximize your weekly benefit while you recover from a work injury. Should you have any questions regarding any of the above, please let us know.

Overview of TTD and TPD Benefits

In Georgia, there are three (3) kinds of benefits which may be payable to a worker that has suffered an on-the-job accident, each payable weekly. This post will very briefly discuss two (2) of the three (3) types of such benefits: Temporary Total Disability (TTD) and Temporary Partial Disability (TPD). These benefits are dubbed “temporary” by the law because a cap is placed on the number of weeks an injured worker can receive them, which is discussed more fully below. The third type of benefits, Permanent Partial Disability (PPD), will be discussed in a later post.

At the outset, it is important to note that the term “disability” as used in the context of TTD and TPD benefits is defined as being a “diminution in earning capacity.” In other words, an injury which lessens or decreases your ability to earn money at your job is considered a “disability.”

TTD Benefits

As the name suggests, TTD benefits are due to an injured worker when his or her earning capacity has been “totally” impaired; meaning, he or she cannot return to work and is not making any money because of the injury. TTD benefits are computed by taking 2/3 of the worker’s average weekly wage (calculation of average weekly wage is discussed here). However, the maximum amount of TTD benefits which can be received each week is determined by the date of the work accident. Currently, the maximum compensation rate is $500.00 per week (thus, even if a worker’s AWW is $1,500.00 per week, he or she is only entitled to $500.00 per week in TTD benefits). Also, an injured worker can receive TTD benefits for a maximum of 400 weeks from the date of injury (unless the injury becomes “catastrophic,” which will be discussed in a later post).

TPD Benefits

Alternatively, if a worker has not been completely disabled and is able to return to work in a limited capacity (working fewer hours), or if he or she has been placed in a “light-” or “modified-duty” job which pays less than the job he or she held prior to the injury, TPD benefits come into play. If there is a loss in wages after the injury, the worker is entitled to recover 2/3 of the difference between the AWW wage before the injury and the AWW after the injury. However, TPD benefits are currently capped at $334.00 per week, and cannot be received for longer than 350 weeks from the date of injury. (Example: pre-injury AWW is $400.00 and post-injury AWW is $300.00. Worker is entitled to $66.67 of TPD each week, which is 2/3 of $100.00).

This can obviously get complicated, so if you have any questions, please let me know!

I was hurt at work. When can I receive workers' comp benefits?

In the event that you are injured on the job, you’re not automatically entitled to workers’ compensation benefits (other than medical treatment) for the first, second, or third day you miss work because of the injury. How many days do you have to wait before you can receive income benefits? In Georgia, a 7-day “waiting period” must elapse before an injured worker is entitled to income benefits.

Notably, the law counts all calendar days as a part of this waiting period (not just work days), and the days do NOT have to be consecutive. In other words, if you’re injured on a Monday, are out of work on Tuesday and Wednesday, return to work on Thursday, and then go out of work again on Friday, the computation of the waiting period would pick back up on Friday (Friday would be the 3rd day missed). On the 8th day missed due to your injury, your employer is required to start paying you income benefits.

So, now you've missed 7 days because of the injury and you're receiving income benefits. When do you get paid for those first 7 days you missed (the "waiting period")? The law in Georgia states that once an injured worker has missed 21 consecutive days due to his or her injury, the employer is required to retroactively pay income benefits for the first 7 days of disability after the injury.

To sum up, an injured worker must miss a total of 7 days, which don’t have to be consecutive, due to the injury before the employer is required to pay income benefits (again, medical care is provided without having to wait). Furthermore, in order to be entitled to income benefits for the first seven days of disability, the injured worker must miss 21 consecutive days.