Workers' Compensation Frequently Asked Questions
Here are some of the most common questions about workers' compensation law. While these may provide a guide for you, there may be many complicating factors with your workers' compensation case. Contact the downtown Atlanta, Georgia law firm of Long & Holder for your free consultation.
Long & Holder, LLP
Q. The insurer wants to settle my case and to set up a Medicare Set-Aside account. What is that?
A. A Medicare Set-Aside account or MSA is used when you are eligible or it appears you will be eligible for Medicare as a result of receiving Social Security Disability Income benefits. Medicare is not supposed to pay for treatment which you have received as a result of your injury. The amount of the MSA is an estimate of how much your future medical treatment that Medicare would otherwise pay would cost. After settlement, you must place the money for the MSA into a separate account to be used only for payment of medical treatment and related expenses arising from your work injury. Your failure to properly use this money and account for it can result in a denial of Medicare benefits for other non-work related medical treatment.
Q. I haven't returned to work but my weekly benefit checks have been reduced. Can they do that?
A. It depends. If your doctor has released you to light duty and if the insurer complies with the many technical requirements of the law,your benefits can be reduced from temporary total to temporary partial but only a year later. We would need to see all of the paperwork to give you an accurate answer.
Q. Do I have to remain in Georgia in order to get Workers’ Compensation benefits in my claim?
A. No. You can continue to receive your weekly benefits no matter where you are living. The insurer must provide you a doctor convenient to your new residence.
Q. I am receiving the maximum amount of Georgia Workers’ Compensation benefits in my case. I understand that the maximum amount was increased on July 1, 2007. Am I eligible to have my benefits increased?
A. No. You are locked into the maximum amount of weekly benefits in effect on the date of your accident.
Q. Can I be fired for making a Workers’ Compensation claim?
A. Yes, under Georgia law. Georgia is an employment at will state. In general, unless you have an employment contract or are the victim of discrimination, you can be fired for any reason. The Georgia legislature rejected a bill preventing such firing for making a claim many years ago.
Your termination can be significant, however. If you are on regular duty work with no restrictions and you are fired, then you will not be entitled to further temporary total benefits unless a doctor later said that you had some restrictions or said that you could not work.
On the other hand, if you have some restrictions when you are fired, you may be entitled to workers' compensation benefits. If you have been fired for reasons related to your workers' compensation claim, your temporary total benefits should start immediately and you need not seek employment. If it is not apparent that you were fired for making the claim, you will probably need to look for work and prove that the reason that you could not find work was on account of your workers' compensation claim and the lingering effects of your injury. If you can prove this then you would be entitled to temporary total benefits.
While you have no claim under Georgia law for being terminated, you may have rights under the federal Americans with Disabilities Act or other federal laws. Our firm does not handle such cases but we can refer you to an attorney who does.
Q. Am I personally responsible for my medical bills?
A. Not if you have an accepted claim and if you have seen the authorized treating physician. Georgia law prohibits the medical provider from billing you for such services.
Q. When can the insurance company stop my benefits?
A. That is a very complicated question. There are limits on how long you can receive benefits. Without regard to these time limits, there are essentially 3 situations in which the insurer can stop your temporary total benefits without going to the State Board of Workers’ Compensation for permission. (There are many other situations in which the State Board can suspend benefits.) First, if the authorized treating physician returns you to work on regular duty with no restrictions. Second, if you return to work making the same amount of money as you were making when you were hurt. Third, if the insurer follows the procedure set forth under O.C.G.A § 34-9-240 and Board Rule 240 concerning offering you light duty work and you do not try to do it.
Q. I am applying for Social Security Disability Benefits. If I get them, will they be reduced because I am receiving Georgia Workers’ Compensation benefits?
A. Perhaps. The total of your workers' compensation benefits and your social security disability benefits cannot exceed 80% of your average monthly or current earnings. Usually, when your workers' compensation case is settled, the documentation of the settlement agreement can be drawn so as to recoup a large portion of this lost offset.
Q. I think someone from the insurance company is watching me. Can they do this?
A. Yes. It is legal to perform surveillance. The insurance company in your case is likely to be trying to see if your restrictions are less than you and your doctor say they are. Avoid doing any strenuous activity outside. The insurer will try to make it look like there is nothing wrong with you. While you may be able to bend over and pick something up once, this does not mean that you can do it all day. They may make a videotape that may be very misleading. Be smart and protect your rights in your case.
Workers' Compensation Basics:
What is workers' compensation?
The workers' compensation system was developed to provide speedy payment of income benefits and medical bills without the necessity of proving fault on behalf of the employer, co-workers or third-parties. Usually the employer purchases a workers' compensation insurance policy which will pay these benefits.
Are you covered under workers' compensation laws?
In general, if your employer has 3 or more employees and you were injured performing a task that arose out of, and in the course of your employment, you will be covered under Georgia Workers' Compensation law.
Do I really need an attorney?
Enforcing your workers' compensation rights at times can be a challenging situation. Complicated forms and procedures must me followed. It is often very wise for an attorney to represent you because of the skill needed to win your case. Our experience has taught us to get the maximum amount of benefits for injured workers.