Georgia Law Blog

Question: Why won't the workers comp insurance company or my job pay for my doctor and medical treatment when I got hurt at work? What you can you do?

I was asked this very question this week. The answer is simple. In Georgia, if an employer/insurer controverts or denies your workers' compensation claim, they have no obligation to pay for any medical treatment if and until you either (a) come to an agreement whereby your case is deemed compensable and/or a doctor is agreed-upon to treat you; (b) your employer and insurance company voluntarily "pick-up" your claim and offer you medical treatment; or (c) I take your case to court before an Administrative Law Judge of the State Board of Workers' Compensation and win.

One legal method that I employ that I do not see used very often is to request that the judge appoint a certain doctor for a one time evaluation at the expense of the employer and insurance company. This is done under O.C.G.A. 34-9-101. I am surprised at how many lawyers representing injured workers do not know about this Section or utilize it.

Of course, I also tell my clients that their company and the insurer will certainly be happy to send them to medical evaluations in the form of Independent Medical Evaluations. (Please understand, however, that these doctors are not generally treating you and making you better. They are simply evaluating you and providing a report to give to the judge when you go to court).

I help injured workers across the State of Georgia, but mainly in the Atlanta and the West Georgia area (Douglas County, Paulding County, Carroll County, and Cobb County). My office is in Douglasville. I will personally come to you if you cannot come to me if I think I can take your case after an initial free consultation on the telephone. Please call my office anytime at (770) 577-2227 or submit your question on this Blog. To read more about my law office and my qualifications, click here.

Posted by Jack E. Clay | Permalink | Email This Post

Posted In: Workers' Compensation Medical Benefits

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When someone is injured on the job, they may find themselves overwhelmed by the changes in their life. Work injuries are not only unexpected and painful, but can also be life-changing. If someone is hurt at work, it is important for the injured worker to seek legal advice to ensure that their rights are being protected.

In a previous post I referred to certain myths that, as a Douglasville workers’ compensation attorney, I clarify for many of my clients. One misconception that injured workers have is that they can treat with any doctor they choose in all cases. This is not correct. However, I have successfully fought against insurance companies to get my clients to better doctors in many cases.

To put it simply, injured workers are entitled to a one time change of physician in most cases if there is a validly posted Panel of Physicians. An injured worker may be entitled to new doctor if a Panel of Physicians is not posted. Many times during the course of a workers’ compensation case, the injured party wishes to obtain a second opinion about his or her on the job injury. This often happens if a serious procedure has been recommended or if the person is dissatisfied with their current physician. An injured worker is entitled to a one-time Independent Medical Evaluation with a doctor of his or her choosing if they have received weekly income benefits within the past 120 days. However, it must be noted that the insurance company is not required to authorize a change of physician just because the employee is unhappy with his or her current doctor.

If you or a loved one has been injured in a work accident or are unhappy with your workers' compensation doctor, please call my Douglasville injury law firm for a free consultation.

Posted by Jack E. Clay | Permalink | Email This Post

Posted In: Workers' Compensation Medical Benefits

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    You cannot build a house without a strong foundation, or so the saying goes.  As I explain to my clients, an injured worker is entitled to four types of benefits in a workers' compensation case under Georgia law.  In a very broad sense, these are the basics to which an injured worker is entitled.
    First, an injured worker is entitled to income benefits.  These weekly benefits are either temporary total disability (TTD) benefits or temporary partial disability benefits (TPD).  The only difference between the two is that an injured worker gets TTD while completely out of work.  If the injured worker returns to work and earns less money because of the injury, the worker gets TPD benefits.  Currently, the maximum weekly TTD benefit is $450.00 per week.  In most cases, this is figured by calculated by averaging the injured worker's weekly pay over the 13 week period prior to the injury.  This figure, called the Average Weekly Wage, is multiplied by 2/3 to arrive at the Compensation Rate.  Example: an injured worker earned, on average, $600.00 each work over the 13 week period before the on-the-job injury.  They would get workers' compensation in the amount of $400.00 weekly, assuming they have a valid claim.
     The second type of benefit an injured worker can get is medical benefits.  The law says an injured worker is entitled to medical benefits that will effect a cure, give relief, or return the worker to suitable employment.  Technically, an injured worker is entitled to lifetime medical benefits.  The most traditional benefits include doctor care and hospitalization.  Medical benefits can also range from prescriptions to medical devices.  Medical benefits can even include paying somebody, even a fried or family member, to help care for an injured worker, typically after a surgery.  This is referred to as attendant care.  Medical benefits can even include payment for a gardener to do yard work if the doctor is willing to order it on behalf of the injured worker.
     The third type of benefit available is payment based on a  permanent partial disability (PPD) rating.  Typically, a doctor will assign a percentage rating to an injured worker based on a number of factors.  The ratings are supposed to be based upon the American Medical Association Guide to the Evaluation of Permanent Impairment, 5th Edition.  In a case I worked on earlier today, my client was assigned a 25% whole body Permanent Partial Disability rating.  This rating is used to compute the amount an injured worker will receive, based on a formula.  An important point is that the percentage ratings can vary among different doctors.  I have typically seen lower percentage ratings from doctors who are known to be friendly to the insurance companies (imagine that!). 
     Rehabilitation benefits are the fourth type of benefits.  Unfortunately, the law only allows these benefits for the most seriously injured workers who have catastrophic injuries.  Rehabilitation benefits can include  home modifications,  educational programs, and special vehicle modifications.
    Stay tuned!  In the future, I plan to post more detailed information about each of the above benefits.  I advise all clients with valid cases to hire a workers' compensation attorney (whether it is me or somebody else)  due to the complexity of workers' compensation law.  The waters of Georgia workers' compensation are choppy and, often, unpredictable.

Posted by Jack E. Clay | Permalink | Email This Post

Posted In: Workers' Compensation Income Benefits , Workers' Compensation Information , Workers' Compensation Medical Benefits

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