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Home » Terminology in workers’ compensation: Glossary

Terminology in workers’ compensation: Glossary

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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.

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James Hills
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23:49 03 Dec 24
I’ll try to make this short! Unfortunately this is my second accident in my life but what it allowed me to do is come in with experience and the ability to compare the efforts and abilities of a good law office from a great law office and GA Injury Advocates are a great office. First off, you get to a paralegal immediately and within days you’re speaking to your attorney directly. Second, you get great communication through the process. No hunting a person down to get updates, no long periods of dead air. Also, the speed to which they handled my case was significantly faster than my last experience with another firm. Lastly, and I can only speak to my case of course, they got me significantly more than I expected and more than they initially expected. They really do fight for you and I cannot emphasize enough how lucky and grateful I am to have chosen them to represent me. Thank you Ivette, John-Paul, and Ramiro!
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Ram knows all
LaN'se Cooper
LaN'se Cooper
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Very Hands-On, return calls in appropriate times, communicated very well - didn't have to chase him down at all. Did everything a lawyer supposed to do although I felt like the opposing team should have gIven more.
Amber Nelson
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Oh my goodness, I cannot even begin to explain how amazing the team at the law office was when helping me with my car accident case. Ivett, the paralegal, and LaBouff, the superstar duo, were like my personal cheerleaders throughout the entire process. They went above and beyond to make sure I was in the loop every step of the way, keeping me informed and calm. I felt like I could ask them anything, and they always had the most patient and professional responses. Their support truly turned a stressful situation into a much more manageable one. I can't thank them enough for all they did for me!
HB Lee
HB Lee
17:02 29 Mar 24
John Paul and his team are top-notch! They kept me informed all along the way. I would recommend highly!
John Davis
John Davis
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GA injury Advocates is an amazing firm to work with. Mr. John Paul and his staff kept me informed throught the entire process and always considered my best interest when giving advice on how to proceed with my case. I highly recommend GA Injury Advocates because their level of customer service and dedication to their clients is unmatched.
Melissa Scott
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20:24 08 Mar 24
Had the pleasure of working with Mr. Rumiro! He was very attentive and actually cared about my well being. I appreciate him so much. Anytime you’re in need of an inquiry advocate please reach out to Mr. Rumiro.
Ivette Sanchez
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Excelente attorney! Always does great work and a very good person. I've had several cases and haven't been disappointed
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Xavier Williams
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Absolutely amazing!
PrinceVicJ
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22:38 27 Feb 23
The best Injury lawyers in GA 🙏 Thank you so much for everything you do for me and my family.
A Fowler
A Fowler
18:54 26 Jan 23
The GA injury advocates are the absolute best injury attorneys in the entire South East region. The lawyers with John Paul "Esquire" & associates were the best in this process and fought extremely hard without prejudice, and also went above and beyond to get me a very satisfying settlement!Sincerely, I'd like to thank you guys for helping me with my case!
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It's a great staff, who is really engaged with their client's situations
Edwin Aviles
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"I don't want to lose my job" something as simple as this, you believe you wont have trouble getting worker Comp from right ? WRONG the fact that i work even a month with a messed up knee in the job trying everything to keep it and be in good term with the company. I'm toss out. I was so lost in the process cause the fact they're were denying me cause of how late i apply for it and the fact i was still walking was more then enough reason for them to say i'm good. Wasn't having it so i came here cause i didn't know where to look and let me tell you John Paul LaBouff is the go to man/bro/boss whatever guy you need cause he'll make sure the insurance company get a run for there money literally. (Update 9/12 : WE WON I CANT BELIEVE WE WON! after many months that has pass from me being AWOL a bit and him in the background doing as much as he can to do everything he can to not only get me an settlement but to make sure I was ok and honestly the best lawyers to go to for anything not just cause of issue but really would not bat a eye to help as much as possible and I can’t express how much I’m grateful for him and his team to make all this happen. Don’t hesitate to reach out cause it’s one call that they will definitely change your life fr!🔥
Tameka Wilburn
Tameka Wilburn
11:47 05 Jan 22
I used their services recently for a workers compensation case. This was the best experience ever. My attorney, John Paul always returned my calls asap. His team, Ivette, Anna and Daniel were so professional and kind. Please use them they will always help you and even when you're upset they are complete professionals. They also got me way more money than I expected. Thanks so very much guys! God bless you all and your families!
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04:43 04 Nov 21
Everything about this business is very true. They made sure that I was taken care of and they communicated with me throughout the whole process. I'm very thankful to have used them as my representatives. They went out and beyond. Thank you.
Ashley Williams
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00:45 26 Jul 21
To be fully honest,  no amount of words can ever express how amazing my lawyer John Paul Labouff has been, as well as  the best paralegal there is, Ivette Sanchez. They're a unstoppable team who genuinely worked hard on my case, as well as thorough. John Paul even brought in another attorney to advise him on my unique situation.  I will forever be grateful to them, and everyone at GA injury advocates. They worked quickly but carefully and made sure I got every ounce of what i deserved and more.  From a business stance they are air tight.  On a character level, I feel as though they are the type of friends you'd want in your life forever.   Even after my case was settled and their job was done. They were immediately there for me when I had an issue with my bank that I didn't know how to handle. They both were happy to help me sort through the issue, and encouraged me to reach out any time i needed them.I feel choosing anyone else to represent you, would be a mistake.John Paul & IvetteI personally want to say thank you so much again.  You truly changed my life to the better
A Evans
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I had a wonderful experience with these guys. Made the process super simple for me. Referred me to a terrific chiropractor after my accident. Worked hard on my case, especially Ivette, she's great.....explained everything to me step by step in great detail. The lawyers are not only very competent but empathetic and personable. I definitely recommend working with this firm.
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Best car injury attorneys kn atlanta. Got the best deal for case and it was settle quickly. I would highly recomend them. They do an excellent job. Thanks John and Ivette!!!!
Rafael Nieves
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GA injury advocates are a very professional Group they go the extra mile to make sure you're Happy. The staff it's very professional as well Ivette Sanchez is a very special employees I'll use them anytime anywhere.
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Beavers Family
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A big thank you to Rodriguez and Associates for getting me the maximum settlement for my Personal Injury claim. I was involved in a terrible car wreck on April 1, 2019 and received my settlement on September 18, 2019! Mr. Rodriguez and his wonderful office staff were very helpful during the process and did a great job keeping me informed of the developments during my case. Mr. Rodriguez effectively negotiated the settlement with three different insurance companies in just a matter of months. I couldn’t be happier with the outcome considering the terrible circumstances. I highly recommend GA Injury Advocates. Thanks again so very much!
Andy Sanchez
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I got information every set of the way, Ivette is great.
Johnny Sanchez
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Ivette does great work, always maintained me updated
Ary Reyes
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Ivette sanchez stood with me until the end of the process.Kept me updated and informed me until the process was done. 100% recommended!!
Kimberly .mlove
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G H
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Ivette is Great!!She’s very attentive and makes sure all your needs are reached. They do everything in a timely manner, and make sure to keep you updated at all times.You are always able to reach a live person on the phone. Great staff! Highly recommended :)
Jose Chaires
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22:10 18 Feb 19
Mr.Erkic did an amazing job with the way he handle the case.I am happy with the results that came out.He did a fantastic job
Marilly Alvarado
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They were super amazing ! Erick Lara kept me updated on everything! Every detail i needed to know I was aware of it ! I recommend this attorney to anyone that gets into an accident !
Cesar Montoya
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15:05 16 Oct 18
As a customer for years, if you like personalized and exceptional service, this firm is the one to hire. Not only do they follow up until cases are completed, everyone in the office is a friend. You will not be disappointed.
Ray Aguiar
Ray Aguiar
00:54 04 Oct 18
I get requested very often to rate individuals, products and companies. I never really fulfill these requests because I don't have time, I am not interested, or I don't have a strong reason why! Today I have a good reason and his name is Erick Lara Paiz. Erick the legal assistant with Rodriguez & Associates, a law firm that represented me in a car accident injury. Erick is a very respectful and well spoken person. He is extremely knowledgeable and always more than willing to help. Erik is great with keeping me informed with what is going on with the case. I love the fact that anytime I call with questions on inquires Erick will almost ALWAYS answer. In the event that he doesn't pick up and I leave a message, he calls me back so QUICKLY. Anybody who is looking to hire a law firm to represent them. Please give Rodriguez & Associate a call and ask for Erik Lara Paiz!
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