Following are a series of frequently asked questions (FAQs) and answers about workers compensation insurance.
Q: What is workers compensation?
A. Workers compensation is an accident insurance program paid by your employer which may provide you with medical, rehabilitation and income benefits if you are injured on the job. These benefits are provided to help you return to work. It also provides benefits to your dependents if you die as the result of a job-related injury.
Q: How long do I have to work to be covered under workers compensation?
A. You are covered from the first day on your job.
Q: How do I know if the company I work for is covered by workers compensation?
A. The law requires any business with three or more workers, including regular part-time workers, to have workers compensation.
Q: When should I report an accident that happened on the job?
A. You should report any accident to your employer (boss, foreman, or supervisor) immediately. If you wait longer than 30 days, you might lose your benefits.
Q: What do I do about a doctor?
A. Your employer is required to post information identifying medical care providers. Your employer may satisfy this requirement in one of the following ways:
1. Post a Traditional Panel of Physicians consisting of at least four doctors. You may choose any one of the four. The panel must include one orthopedic physician and not more than two industrial clinics. Where possible a minority physician must be included. You may make one change to another doctor on the list without the permission of your employer.
2. Post a Conformed Panel of Physicians consisting of at least ten physicians. This panel shall include the same physicians required in the Traditional Panel plus a chiropractor and a general surgeon. You may make one change to another doctor on this panel without the permission of your employer.
3. Post the name of the Workers’ Compensation Managed Care Organization (WC/MC0) certified by the Board which your employer has contracted with to provide medical services. Your employer must give you a notice of the eligible medical service providers and post a 24 hour toll free number for the managed care organization. A managed care representative will assist you in scheduling an appointment with the eligible medical provider of your choice. You may make one change to another eligible physician at any time, without the permission of your employer.
Q: Who pays for the doctor?
A. Your company’s workers compensation insurance carrier will pay for your authorized doctor’s visit if the injury was caused by an accident on the job.
Q: What medical treatment will be paid?
A. All authorized doctor bills, hospital bills, physical therapy, prescriptions, and necessary travel expenses if the injury or illness was caused by an accident on the job. You may also be entitled to medical rehabilitation.
Q: When do I get my benefits?
A. You are entitled to weekly income benefits if you have more than 7 days of incapacity. Your first check should be mailed to you within 21 days after the first day you missed work. If you miss more than 21 consecutive days, you will be paid for the first week.
Q: How much will my weekly benefits be?
A. You will receive two-thirds of your average weekly wage, but not more than $300.00 per week for an accident which occurred on or after July 1, 1996, or $325.00 for an accident which occurred on or after July 1, 1997.
Q: How long will I receive weekly benefits?
A. If your accident occurred on or after July 1, 1992 you are entitled to benefits for up to 400 weeks. If your injury is catastrophic in nature you may be entitled to lifetime benefits. In certain circumstances, your benefits may be reduced after you have been released to return to work with limitations or restrictions, or suspended if you are released to return to work with no limitations or restrictions.
Q: What if I am able to return to work but can only get a lower paying job as the result of my injury?
A. You will receive a reduced benefit based upon your earnings. This benefit will not exceed $192.50 per week if your accident occurred on or after July 1, 1994, or $216.67 if your accident occurred on or after July 1, 1997.
Q: What if my injury keeps me from getting a job?
A. Under the law, if you sustain a catastrophic injury, you are entitled to receive help in getting another job or learning to do another job. If you need help in this area, call the State Board of Workers’ Compensation at (404) 656-3784.
Q: What kind of benefits will I receive if I have a permanent disability?
A. You will receive weekly benefits based on the type and extent of your permanent disability. The authorized treating physician determines any percentage of disability or bodily loss ratings based upon Guides to the Evaluation of Permanent Impairment, fourth edition, published by the American Medical Association.
Q: What benefits will I receive if I lose a leg, arm, or other part of my body?
A. You will receive benefits based upon an amount set by law. For example, if you lost an arm or leg you will receive benefits for 225 weeks.
Q: Can I be compensated for loss of sight or hearing?
Q: Can I receive benefits if I have lost the use of a part of my body?
A. Yes. Benefits are based upon the extent of loss of use of a part of your body as determined by the authorized treating physician.
Q: If I die as the result of an on-the-job accident, what benefits will my dependents receive?
A. Your dependents will receive two-thirds of your average weekly wage, or a maximum of $300.00 per week for death on or after July 1, 1996, and $325.00 per week for death on or after July 1, 1997. Your dependents are your surviving spouse, children or stepchildren. A widowed spouse with no children is limited to a total amount of $100,000.00 unless he or she remarries or cohabitants in a meretricious relationship.
Q: Can I be paid Social Security disability and workers compensation at the same time?
A. Yes, but Social Security benefits may be reduced.
Q: What if I don’t receive my workers compensation benefits?
A. You must file a claim to protect your rights within one year from the date of your accident. This is accomplished by filing Form WC-14 with the State Board of Workers’ Compensation.
Q: What happens after I file a claim?
A. If you do not receive any benefits, you may request a hearing before the State Board of Workers’ Compensation at the above address. A hearing is like a trial in the courts of Georgia. Your case will be decided by an Administrative Law Judge who listens to both sides of the case and determines what benefits, if any, you should receive. The judge’s decision will be based on the law and the facts involved.
Q: When will the hearing take place?
A. The hearing generally will be scheduled within 45-90 days from the time the judge received the request.
Q: Where will the hearing take place?
A. The hearing will generally be held in or near the county where you were injured.
Q: Do I have to have a lawyer represent me at the hearing?
A. Everyone has the right to represent himself. However, your employer may be represented at the hearing by a lawyer. You may need help from a lawyer in order to present your case properly.
Q: How much will my lawyer charge me?
A. The attorney fee will be based on an agreement between you and your lawyer, subject to the approval of the State Board of Workers’ Compensation.
September is Life Insurance Awareness Month.
It’s the perfect time to remind ourselves to plan ahead for the ones we love.