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Workers’ Compensation Laws
These are complex laws applied at both the federal and state level in regard to employees who’ve been injured or disabled on the job, and such also applies to the dependents of workers killed due to work-related accidents, injuries, and illnesses. The intent of such laws is to reduce, or even eliminate, the need for legal litigation by offering a fixed monetary award system for such employees to pay for medical bills, rehabilitation, and lost wages regardless of whether or not the injury was a result of their own negligence or fault. In exchange for this no-fault factor, rights to seek higher compensation are often forfeited unless certain exceptions exist, which also helps to protect co-workers and employers from unknown, excessive liability faults. Federal workers’ compensation laws are limited to federal employees and specific areas of interstate commerce. Meanwhile, individual state statutes establish the framework for their respective state’s workers’ compensation programs, which are not all exactly the same.
Workers’ Compensation Insurance
Often referred to as “workers’ comp,” these programs are enacted and overseen by state officials. The federal government oversees its own program, but it only applies to select interstate groups and federal employees. Most states require businesses within their state to carry this insurance, which offers a fixed monetary system for missed wages, medical expenses, rehab, and death, but it’s important to understand that each state may have its own unique exemptions and requirements. Texas, for example, has made their workers’ compensation insurance program optional for all businesses. Premiums paid by the employer and benefits received by the employee are typically set by each state after factoring in their unique economy and presence of high-risk industries. Given the vast differences in each state’s workers’ comp programs, it’s prudent to consult a legal specialist to determine applicable coverages and benefits per state.
Workers’ Compensation Claim
For injured employees to receive workers’ compensation insurance benefits, they must follow the appropriate claims process as outlined by their respective state. This is a request for benefits, not a lawsuit, by the employee. In most cases, there is a deadline in which the employee’s and employer’s parts of the claim must be initiated. Claims should be completed anytime the worker suffers an injury, exposure, accident, or disease as a result of their work activities. Step one is to report the injury to the employer. The employer then provides the worker with the necessary paperwork and information on their rights and potential benefits. The employer is typically responsible for filing the claim with the state workers’ comp board and insurer. The insurer can either deny or accept the claim based on the information provided. Likewise, the employee can then either accept the benefit amount or negotiate for a different amount. If denied, the employee has the option to appeal.
Workers’ Compensation Benefits
These are the structured funds an injured worker receives as the result of a workplace injury, illness, disease, or accident, and it includes dependent benefits upon death from such causes. The funds are used to diagnose and treat/manage the medical issue, pay lost wages while unable to work, and cover rehab or retraining costs necessary to return to work. Benefit amounts and placements vary per state, hinging on factors such as state law, nature and prognosis of injury, and earnings prior to injury. Benefit amounts are usually accepted when the injury is minor, but, in cases of more significant injures, it may be necessary to obtain legal representation to seek a more fair and accurate benefit settlement from the insurer.
Workers’ Compensation Carriers
Each state sets the foundation for their workers’ compensation program, but it’s often up to the employer to select and secure an insurance company, or carrier, to provide the required insurance. Other states have a state-based monopolistic workers’ comp fund that the employer pays into to fund. Self-insure options must meet qualifiers, meaning it adequately provides coverage in accordance with what the state demands. Workers’ comp insurance is offered by a number of carriers via both the standard and excess and surplus marketplace. Assigned risk plans are necessary for employers not able to otherwise obtain coverage from a standard insurer. In any case, the employer pays the premium for their workers’ comp policy, and the insurer guarantees preset benefits to the covered employees. Many carriers also offer measures and tools to help mitigate the prevalence of workplace accidents and injuries and assistance in helping injured employees effectively and efficiently return to work safely.
Workers’ Compensation Case
The process for injured workers begins by making a claim, but it can quickly escalate to appeals and even litigation. Whether it be from a missed deadline or a dispute, some workers’ compensation claims are denied by the insurance carrier. It can also be that the insurance carrier offers a benefit that seems incorrect in its amount, and the worker doesn’t want to accept the offer. In either case, this leads to the appeal process, which can be long and difficult without the guidance of a legal professional to handle to case. Many other factors, such as employee retaliation, Social Security disability benefits, permanent disability, and so forth can also complicate a workers’ compensation case and lead to litigation needs.
Workers’ Compensation Lawyer
In cases of uncomplicated, minor injuries and reputable employers and insurance carriers, workers’ compensation is a straightforward process of injury meets ask and receive benefits. However, such isn’t always the case. Of course, as a state-by-state system, workers compensation programs often vary greatly in the caveats of responsibilities, benefits, and procedures. Workers’ compensation lawyers offer the legal expertise on workers’ compensation processes and rules in their respective states. This legal representation can be instrumental during the appeals process and should the claim become a case for legal litigation necessary to get the benefits the claimant deserves and is entitled to receive from the carrier. If there’s any question average weekly wage calculations, return to work demands, maximum medical improvement, or the denial or acceptance of a claim, it’s always best to seek the guidance of a workers’ compensation lawyer.
The Workers’ Compensation System
Prior to workers’ comp legislation, an injured employee was almost certain to present their injury and any restitution sought before a court to decide. It was a tedious, costly process for all parties and often sought to shift blame from party to party. The workers’ compensation system was designed to offer an automatic, no-fault, social benefit upon injury or death in exchange for keeping as many personal injury cases out of the legal system as possible. The employer secures insurance coverage that pays a prescribed benefit to injured workers and death benefits to dependents. Each state mandates their own terms and conditions as to who must have the insurance, what and who it must cover, and the amounts and reasonings behind paying claims. It’s also important to note that the systems generally contain civil and/or criminal penalty for both false claims and failures on the employer’s part in securing any required workers’ compensation insurance. The workers compensation system can be complicated to navigate without legal assistance to ensure the injured workers’ rights and interests are legally protected.
The Georgia Workers’ Compensation Act
Adopted in 1920 and codified as title 34, chapter 9, of the Official Code of Georgia Annotated, the Georgia Workers’ Compensation Act makes any Georgia employer with at least three employees obtain self-funded or state-run workers’ compensation insurance. Certain exclusions, such as railroad and domestic workers, apply. Income benefits in the amount of two-thirds the workers’ average weekly salary up to the capped amount of $675, medical care from approved physicians, permanent/partial disability payments, and payment to a deceased workers’ dependents, are included. It also allows for disputed claims to be decided in non-jury hearings overseen by administrative law judges and an appeals process for review, which offers swift action for injured employees needing monies for medical and living expenses whilst limiting the employer’s liabilities in injury lawsuits that could otherwise bankrupt the business. The statues and rules of the Georgia Workers’ Compensation Act are updated as needed and as bills are passed during legislative assembly sessions. Answers to FAQ, such as timing of accident reports, approved medical care providers, and duration of benefits, are all answered within the Act.
The State Board of Workers’ Compensation (SBWC)
In Georgia, the SBWC was established in 1920 and is funded by self-insured employers and insurance company assessments. Since that time, it has functioned as a swift and just access point for injured workers and employers to the Georgia Workers’ Compensation program for the resolve of claims and safe return to work. In addition to managing state resources and being a reliable source of information on the claims and mediation processes, the SBWC offers educational opportunities to prevent and deal with the aftermath of workplace injuries and help employees successfully return to work following and accident. The SBWC’s Enforcement Division handles reports of fraud and employer failures to secure the appropriate insurance.
Repetitive Motion Injuries
While some workplace injuries are the result of an acute, immediate, single accident or exposure, many are the result of repetition over a prolonged period of time. Many expensive and debilitating injuries are the result of repetition of movement, which stresses, strains, and deteriorates the soft tissues powering the movement. Over time, the stressed body part becomes injured or unable to function properly. Some of the most common RSIs are carpal tunnel, bursitis, tendonitis, rotator cuff injuries, and muscle strains. Ergonomics, which emphasizes proper body mechanics and positioning, helps to curtail the number of repetitive stress and motion injuries, but it can’t fully solve the problem in all industries and work place environments, especially those with repetitive tasks inherent to completing the assigned job. RSIs are generally included as workplace injuries qualifying for workers’ comp benefits, but some states make it necessary to prove the injury was a result of work place duties, not everyday personal activities. A legal team may be necessary to collect such evidence for a successful workers’ comp claim following a RSI.
Acute Accident at Work
Acute workplace accidents are those that have an immediate cause and effect, and it involves innumerable scenarios. These include accidents like slips, falls, and trips; cuts and dismemberments; sudden impacts with objects or coworkers; sprains and strains; vision and hearing accidents, and so forth. These accidents can occur because of the injured workers negligence, a coworkers negligence, unsafe conditions, or equipment malfunction, and they make up the bulk of workers’ compensation claims. For workers’ compensation benefits, regardless of fault, the injury must have occurred or arisen out of employment, which often includes work-related travel and off-site work tasks for mobile employees. The employer must complete the proper accident and incident paperwork within the allotted timeframe and assure the injured worker has immediate access to medical care from a qualified provider.
