Frequently Asked Questions
Answers from Our Cobb County Workers' Compensation Attorney
At Herbert Chestnut & Associates, we have collected a list of common questions that clients have for us. We have provided this list below to help our clients better understand their rights and what they can expect from their workers' compensation cases. If you have a question that is not listed below, feel free to contact our Cobb County workers' compensation lawyers.
- What Is Workers’ Compensation?
- Does my injury have to be my employer’s fault?
- If I accidentally hurt myself, is that covered?
- Is workers’ compensation the same in all states?
- Why do I only get $525.00 per week?
- If I am released to light duty work, is my employer required to hire me?
- Do I have to return to work with my employer?
- Do I have to go to the doctor my boss tells me to go see?
- Can I get a second opinion?
- If the employer / insurer sets up a second opinion, do I have to go?
- How is my income benefit calculated?
- Who should I choose to treat my injuries?
- What if there isn’t a Panel of Physicians?
- Is my employer required to explain the Panel of Physicians and other procedures to me?
- What should I do if a medical bill is sent to me?
- Is the employer or insurer required to pay my medical bills regardless of how much they are?
- If the employer / insurer doesn’t pay all of my bills, am I responsible for the remainder?
- Is the employer / insurer responsible for mileage?
- What Injuries are covered under workers’ compensation?
- Can I collect workers’ compensation and sue my employer?
- How long do I have to file a claim?
- Can I receive both workers’ compensation and Social Security benefits?
- How long do workers’ compensation benefits last?
1. What Is Workers’ Compensation?
Workers’ compensation is an insurance program financed by employers that provides injured workers with income, medical, and rehabilitative benefits in the event that they should be injured throughout the scope of their occupation. Workers’ compensation also provides death benefits to the dependents of deceased workers in the event that a worker should pass away in a work-related accident. Under Georgia law, all employers with three or more workers must have workers’ compensation insurance.
2. Does my injury have to be my employer's fault ?
No. Under Georgia law, you are entitled to benefits even if the injury was not the fault of your employer. In fact, under most circumstances, you are entitled to benefits even if you are injured as a result of your own negligence.
3. If I accidentally hurt myself, is that covered?
Yes. However, there are exceptions in certain situations such as failure to use safety appliances or devices when available or required or injuries which result from the use of alcohol or illegal drugs.
4. Is workers' compensation the same in all states?
No. Each state has its own set of rules and regulations as to workers' compensation. Most workers' compensation laws have many similarities but each state has differences which materially affect your rights as an injured worker. In addition, federal employees are covered under one of two Federal Acts. Either the Federal Employees Compensation Act (FECA) or the Longshore and Harborworkers' Compensation Act. There are other Employees who are treated differently as well, such as railroad employees and part-time workers.
5. Why do I only get $525.00 per week?
Under Georgia Law, the Employer must pay 2/3rds of your average weekly wage with a maximum of $525.00 per week for dates of injury occurring on July 1, 2013 forward. The maximum rate changes every year or two and is set by your date of injury. Once your compensation rate is properly set, it generally does not increase for cost of living or otherwise.
6. If I am released to light duty work, is my Employer required to hire me?
No. In certain situations, it is to the Employer's benefit to hire you but nothing in the Workers' Compensation Act requires an Employer to do so. There is also no direct recourse against an Employer who fires an injured worker under the Workers' Compensation Act. However, there may be a discrimination claim against an Employer under those circumstances under either State or Federal Law.
7. Do I have to return to work with my Employer?
The decision on whether or not you return to work with your Employer is yours alone. However, in certain situations, if light duty is offered by the Employer and you fail or refuse to return to work, your workers' compensation weekly checks may be jeopardized.
8. Do I have to go to the doctor my boss tells me to go to see?
It depends. Normally, when you are first injured, the Employer should allow you to select from a "Panel of Physicians". The Panel of Physicians should be posted in a conspicuous place on the job site and its function should be explained to you at the time of your injury. You have the right to choose any doctor from the Panel and treat with that doctor at the Employer or its Insurer's expense. You may also make one change from a Panel doctor to another Panel doctor without the approval of the insurance company or the State Board of Workers' Compensation.
However, at any time during the pendency of the claim, the Employer or Insurance Company has a right to send you for an independent medical exam at a doctor of their choosing. They are allowed to do this with the only exception that the request must be reasonable.
9. Can I get a second opinion?
Yes, within 120 days of having received income benefits, you are entitled to a second opinion under Section 202(e) of the Act, with a doctor of your choice. You may also request permission from the State Board of Workers' Compensation to obtain a second opinion.
10. If the Employer/Insurer sets up a second opinion, do I have to go?
Generally, yes. As stated above, the Employer/Insurer may request a second opinion or independent medical exam under the Workers' Compensation Act. So long as the Employer/Insurer gives the proper notice under the Act and fulfills other obligations, you have to attend. If you do not, the Board can order your benefits suspended until you do attend.
11. How is my income benefit calculated?
Generally, your average weekly wage is determined by averaging the 13 weeks prior to your injury. There are certain exceptions if you do not work the entire 13 week period before your injury. After the average weekly wage is established, your benefits are usually 2/3rds of that amount subject to the maximum rates contained in the Act. The current maximum rate is $525.00 per week.
12. Who should I choose to treat my injuries?
If time permits, contact an attorney to get some advice regarding the doctors listed on the Panel of Physicians (read about the Panel of Physicians in Workers' Compensation from A to Z). If you cannot obtain a recommendation from an attorney, a specialist is generally preferred over a walk-in clinic. Industrial Medical Clinics are generally not preferred.
13. What if there is not a Panel of Physicians?
By law, you have the right to treat with any doctor you choose at the Employer's expense. You should take a photograph of the area in which legal notices are posted at your job site to verify that no panel exists. Also, if a panel exists but it does not comply with the law, for example, if it has less than 6 doctors, it is treated as if there is no panel of physicians at all.
14. Is my Employer required to explain the Panel of Physicians and other procedures to me?
Yes. In order for the Panel of Physicians' rule to apply, not only does a Panel have to be posted but the Employer must take reasonable steps to insure that the Employees know the function of the panel and how properly to obtain medical care and treatment.
15. What should I do if a medical bill is sent to me?
If you are represented, send it to your attorney immediately. If not represented, contact the medical provider and give them the workers' compensation claim information. Finally, it is advisable to write the medical provider and put them on formal notice that the bill is for a workers' compensation injury. Give them the name and address of the insurance adjuster as well as your claim number.
16. Is the Employer or Insurer required to pay my medical bills regardless of how much they are?
No. There are numerous restrictions as to the Employer's/Insurer's liability for medical expenses. First, in an accepted claim, the medical bill must be from an authorized treating physician. Secondly, it must be reasonably necessary to effect a cure, return the Employee to suitable employment or relieve pain in order to be covered. Finally, if both of the preceding requirements are met, the Insurer has the right to reduce the amount of the bill by the Workers' Compensation Fee Schedule.
17. If the Employer/Insurer does not pay all of my bills, am I responsible for the remainder?
No. Generally, if a medical provider accepts a workers' compensation claim, it accepts the payment of the bills pursuant to the Fee Schedule and you cannot be billed for what is written off.
18. Is the Employer/Insurer responsible for mileage?
Yes. You have the right to reimbursement for mileage to and from doctor's offices, hospitals, physical therapy and other medical providers as well as trips to the pharmacy to pick up medication related to your work related injury. The current mileage rate is $.40 per mile.
19. What Injuries are Covered Under Workers’ Compensation?
Nearly any injury or illness that a worker should be afflicted with resulting from their work is covered under worker’s compensation, as long as the injury was not caused by a worker’s recklessness. Slip and falls, stress-related injuries such as carpal tunnel, on-the-job car accidents, and injuries from equipment malfunctions are just some of the many injuries that are covered.
20. Can I Collect Workers’ Compensation and Sue My Employer?
No. In exchange for coverage under workers’ compensation, you waive your right to sue your employer for damages in the event of your injury. In the event that your injury should be caused by someone other than your employer, however, you may be able to pursue financial recovery by filing a claim against the responsible third parties.
21. How Long Do I Have to File a Claim?
You must inform your employer within 30 days of suffering a workplace injury. Failing to do so may cause you to forfeit your right to receive compensation.
22. Can I Receive Both Workers’ Compensation and Social Security Benefits?
Yes, though your social security benefits may be reduced.
23. How Long Do Workers’ Compensation Benefits Last?
The length that workers’ compensation benefits will continue to be paid depends on the extent of a person’s injuries and the time it takes an employee to heal. Generally speaking, benefits will continue to be paid as long as you adhere to all prescribed treatments as determined by your physician. Disability payments will be payable for a maximum of 400 weeks from the date of injury, unless an employee’s injuries are deemed catastrophic.