Georgia Workers Compensation Benefits - What Kinds Of Medical Treatment Am I Entitled To?
by: Aaron Walter
This article is made available for educational purposes only, to give you general information and a general understanding of the law, not to provide specific legal advice. This should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.
Medical Treatment under Georgia Workers' Compensation
The Good News:
Unlike most situations with cash benefits, your medical benefits are basically never-ending. In other words, once you have an "accepted" claim, one in which your employer or their insurer has paid you income benefits or has paid for your medical treatment, your employer owes you treatment related to that injury for as long as it takes to cure you, provide relief, or restore you to suitable employment. This obligation could go on for your entire life depending on the injury.
The Bad News:
Your medical information in workers' compensation is not confidential. Your employer and their insurance company will likely receive a copy of your medical information relating to your work injury. Also, the employer/insurer may not be required to pay for medical treatment from unauthorized doctors.
What doctors/hospitals/clinics can I receive treatment from?
Maybe the tightest held secret in workers' compensation is that your employer is required to and likely has posted somewhere in the deep recesses of your workplace a document called a "Panel of Physicians." This document must contain a list of six doctors or facilities with whom you have the right to seek treatment at your employer's expense. At least one doctor will need to be a licensed orthopedic surgeon. Orthopedics specialize in chronic and traumatic injuries to the body. However, your employer will likely encourage you to go to an industrial clinic for treatment of your injuries. Know that even after visiting this clinic you still have the right to choose to see an orthopedic surgeon who specializes in injuries like yours.
If your employer fails to post this "Panel" or does not allow you to select a doctor from this list they forfeit any control over who you receive medical treatment from. In other words, if you have a compensable work injury, your employer will be stuck paying for any doctor you choose to treat your injuries. For that reason your employer has probably unceremoniously placed this very important document on a wall in a break room next to seldom read minimum wage information, state/federal permits or business licenses, and safety information.
Once you have identified your employer's panel of physicians, take clear a picture of it (many people even have cell phone cameras that can do this). If you have the chance, take it down and make a photocopy of it. If no panel of physicians exits, take a photo of the area in which legal notices are hung where no panel is posted.
If I don't like my doctor, can I get a new one?
An employee is entitled to make one change in treating physicians from one physician to another on the same panel of physicians without any special authorization. Aside from picking a new doctor from your employer's panel you will likely need to have the employer agree to a change. If your employer refuses to allow a change outside the panel of physicians you may make a request to the State Board of Compensation and petition them to allow a change in physicians. This request is make using State Board of Workers' Compensation form WC-200b .
Additionally, if you are receiving any income benefits from your employer, you have the right to one independent examination (known as an IME) by a physician of your choosing at your employer's expense. While this doctor will not become your regular physician, if their opinion differs from your regular doctor it may provide a new direction for your treatment or support a claim for a change of physicians.
Unfortunately, your employer is not limited to one request for an IME and may require you to go to as many independent medical evaluations (IMEs) as they wish to pay for. Failing to attend IME appointments may result is the suspension of your benefits until such time as you attend the appointment.
Reimbursement of mileage expenses
Your employer is likely in no hurry to tell you, but they are required to compensate you for your medically related travel costs. With gas prices as high as they are, your travel expenses may be more considerable than you think. Your employer must compensate you at the rate 40 cents per mile traveled from your home to: your doctor's office, physical therapy, the pharmacy, and any other place of examination or treatment.
If you are required to travel away from your home city, the employer may also be responsible for the cost of meals and lodging.
I encourage you to keep an accurate log of all your mileage and submit it to your employer/insurer each month. If you never submit a mileage log for reimbursement you will never receive compensation for all the gas you burn up as a result of your injuries.
Saturday, February 14, 2009
legal system blog
Georgia Workers' Compensation Benefits - What Employees Are Entitled To Benefits?
This article is made available for educational purposes only, to give you general information and a general understanding of the law, not to provide specific legal advice. This should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.
What is Workers' Compensation?
In Georgia, Workers' Compensation operates as a "no fault" system for compensating injured workers for time missed from work and for costs of necessary medical treatment. The system presents trade-offs for Georgia workers. While it bars claims against an employer for personal injury, it also bars some of the defenses an employer could use against a workers' claim such as "assumption of the risk" or that the injury was caused by a fellow employee.
This system means you cannot sue your employer in State/Superior court for your injuries, like you would in other instances. Instead, an injured employee is compensated according to a schedule set out by the Georgia State Board of Workers' Compensation. Sadly, this means you will not be able to sue your employer for such things as pain and suffering from your injuries.
Exactly who is allowed to make a Georgia Workers' Comp claim?
The foundation of workers' compensation law is in defining who is an employer and an employee for workers' compensation purposes. Unfortunately, it is not always as simple as "I work for Company X, therefore Company X is my employer and I am his employee."
The basic rule as to whether an employee/employer relationship exists involves two seemingly simple criteria; 1) a person in the service of another, who is 2) under contract of hire.
There is no requirement that a work contract be written. Actual pay may not be necessary (ex. Volunteer firefighters or police, elected officials). Minors can still benefit from workers' compensation even if they are working in violation of child labor laws. Also, unlike many states, migrant workers and temporary employees are covered.
However, many types of employment or employers are not subject to workers' compensation. Types of employment not covered by Georgia Workers' Compensation include Domestic servants, Farm laborers, Railroad common carriers, Sports officials (umpire, judge, linesman, scorekeeper, timekeeper, etc.), Licensed real estate salespersons with independent contractor agreements, Partners in a business, and Independent Contractors.
Georgia Workers Compensation does NOT apply to employers that do not have at least three employees operating in the same business within Georgia. These minimum three employees must be "regularly in service" within the state. The term "regularly" does not mean constantly or continuously, only that there is a routine practice by the employer to utilize three or more employees, even if that many employees are working on the date of an accident. In most situations your boss will count towards the three employee requirement.
Independent Contractors
Employers often do everything they can to classify their employees as independent contractors to protect themselves from having to pay workers' compensation to their injured employees. There may be a debate as to whether you are in fact an independent contractor, but if you one, you are not entitled to workers' compensation. While it can be complicated determining whether you are an employee or an independent contractor, below are some of the factors to look at in determining your status:
CONTRACT - Existence of an independent contractor agreement signed by the worker
PAY - An hourly or salaried worker is likely an employee. When a worker is paid on a per-job basis he may be viewed as an independent contractor.
TAXES - If an employer withholds taxes, the worker is more likely an employee. However, just because your wages are reported on 1099 tax form instead of a W-2, your employer has not automatically made you an independent contractor.
TYPE OF WORK - If the workers' job is part of the regular business of the employer, rather than some additional service to the business, it would favor the employer/employee relationship.
JOB "TOOLS" - Who supplies the tools, supplies, or materials of the job? If the worker supplies all their own tools and materials it likely indicates an independent contractor relationship.
HOURS - If the employer controls a workers' hours, it likely indicates an employment relationship.
OVERALL CONTROL - If the employer controls how a worker does their job, as opposed to simply requiring certain results, the worker is likely an employee. These "how" factors focus on the hours, manner, methods, and means of performing the work.
This article is made available for educational purposes only, to give you general information and a general understanding of the law, not to provide specific legal advice. This should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.
What is Workers' Compensation?
In Georgia, Workers' Compensation operates as a "no fault" system for compensating injured workers for time missed from work and for costs of necessary medical treatment. The system presents trade-offs for Georgia workers. While it bars claims against an employer for personal injury, it also bars some of the defenses an employer could use against a workers' claim such as "assumption of the risk" or that the injury was caused by a fellow employee.
This system means you cannot sue your employer in State/Superior court for your injuries, like you would in other instances. Instead, an injured employee is compensated according to a schedule set out by the Georgia State Board of Workers' Compensation. Sadly, this means you will not be able to sue your employer for such things as pain and suffering from your injuries.
Exactly who is allowed to make a Georgia Workers' Comp claim?
The foundation of workers' compensation law is in defining who is an employer and an employee for workers' compensation purposes. Unfortunately, it is not always as simple as "I work for Company X, therefore Company X is my employer and I am his employee."
The basic rule as to whether an employee/employer relationship exists involves two seemingly simple criteria; 1) a person in the service of another, who is 2) under contract of hire.
There is no requirement that a work contract be written. Actual pay may not be necessary (ex. Volunteer firefighters or police, elected officials). Minors can still benefit from workers' compensation even if they are working in violation of child labor laws. Also, unlike many states, migrant workers and temporary employees are covered.
However, many types of employment or employers are not subject to workers' compensation. Types of employment not covered by Georgia Workers' Compensation include Domestic servants, Farm laborers, Railroad common carriers, Sports officials (umpire, judge, linesman, scorekeeper, timekeeper, etc.), Licensed real estate salespersons with independent contractor agreements, Partners in a business, and Independent Contractors.
Georgia Workers Compensation does NOT apply to employers that do not have at least three employees operating in the same business within Georgia. These minimum three employees must be "regularly in service" within the state. The term "regularly" does not mean constantly or continuously, only that there is a routine practice by the employer to utilize three or more employees, even if that many employees are working on the date of an accident. In most situations your boss will count towards the three employee requirement.
Independent Contractors
Employers often do everything they can to classify their employees as independent contractors to protect themselves from having to pay workers' compensation to their injured employees. There may be a debate as to whether you are in fact an independent contractor, but if you one, you are not entitled to workers' compensation. While it can be complicated determining whether you are an employee or an independent contractor, below are some of the factors to look at in determining your status:
CONTRACT - Existence of an independent contractor agreement signed by the worker
PAY - An hourly or salaried worker is likely an employee. When a worker is paid on a per-job basis he may be viewed as an independent contractor.
TAXES - If an employer withholds taxes, the worker is more likely an employee. However, just because your wages are reported on 1099 tax form instead of a W-2, your employer has not automatically made you an independent contractor.
TYPE OF WORK - If the workers' job is part of the regular business of the employer, rather than some additional service to the business, it would favor the employer/employee relationship.
JOB "TOOLS" - Who supplies the tools, supplies, or materials of the job? If the worker supplies all their own tools and materials it likely indicates an independent contractor relationship.
HOURS - If the employer controls a workers' hours, it likely indicates an employment relationship.
OVERALL CONTROL - If the employer controls how a worker does their job, as opposed to simply requiring certain results, the worker is likely an employee. These "how" factors focus on the hours, manner, methods, and means of performing the work.
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