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.

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.

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.

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.  

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.

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.

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.

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.

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.

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.