Georgia Workers Compensation Claims: Eligibility, Filing and Appeals
Workers’ compensation in Georgia is a mandatory insurance program designed to compensate injured workers for medical care and lost wages. Those involved in workplace injuries or who suffer an occupational disease (such as asbestosis) are eligible for benefits.
If a business employees three or more workers, the business most likely must provide workers’ compensation coverage in Georgia. In other words, state law requires the business to have workers’ compensation insurance. You can check whether your employer is required to provide workers’ compensation insurance by going to www.sbwc.georgia.gov and clicking on “How Do I verify an employer’s workers’ compensation insurance coverage.”
Your coverage for workers’ compensation begins the first date you work in Georgia, as long as you do not fall into one of the following categories:
- federal employees
- railroad employees
- independent contractors
- volunteers, or
- domestic workers.
Filing a Workers’ Compensation Claim
You should report any workplace accident or potential occupational disease or work-related illness to your employer as soon as possible. If you wait longer than thirty days, you risk losing workers’ compensation benefits.
Your employer will provide you with the paperwork necessary to file a workers’ compensation claim in Georgia.
Obtaining Medical Treatment
Georgia has specific rules regarding doctors that may treat workers injured on the job. Your employer must post information regarding the medical care providers that you may seek treatment from for work-related injuries and occupational diseases.
When you report your injury or illness to your employer, your employer should give you a list of physicians approved to treat workers with a workers’ compensation claim. This list will have a minimum of six doctors, and you may choose any doctor listed. You also may change doctors, provided that your new doctor is also on the list.
Rather than a list of physicians, your employer may instead post the name of a Workers’ Compensation Managed Care Organization. A representative from the organization can assist you in obtaining an appointment for treatment. You must choose a physician within the organization, but may change physicians within the organization.
Your employer’s workers’ compensation insurance carrier is responsible for covering all proper and necessary medical care related to your workplace injury, illness, or occupational disease. This includes doctor visits, hospital stays, physical therapy, and diagnostic studies, such as x-rays.
If you are unable to work due for more than seven days due to your injury or illness, you are eligible for weekly income benefits. You should begin receiving these payments weekly within three weeks of your first day of missed work.
Your lost wages benefits will pay you up to two-thirds of your average weekly wage, subject to an annual state maximum. As of July 1, 2016, you cannot receive more than $575 per week. These benefits will continue for a maximum of 400 weeks.
Permanent Disability Benefits
If you are permanently disabled, either partially or totally, as a result of your workplace injury or occupational disease, you are entitled to additional monetary benefits. These benefits depend on the nature and severity of your permanent disability. Even if you have a small impairment and can continue working, you can get a permanent disability benefit.
Your doctor will determine the level of your permanent impairment. You will then receive weekly benefits based upon an amount established by law for the body part(s) involved and the degree of impairment. If your injuries are very severe such that you are permanently and totally disabled, you may be eligible for lifetime benefits through a workers' comp pension.
In addition, if your permanent disability prevents you from returning to your job, you may be eligible for vocational retraining services.
Your employer’s workers’ compensation insurance carrier will make many decisions about your claim – from allowing your claim, to authorizing medical treatment, to other decisions. You have the right to request a hearing with the State Board of Workers’ Compensation if you disagree with any of its decisions. A judge will conduct a trial-like hearing and issue a written decision adjudicating the issues involved.
You may appeal the decision of the State Board of Workers' Compensation to the Appellate Division, within twenty days of the judge’s written decision. For more information, see our article on Appealing Workers' Comp decisions in Georgia.