What medical benefits will I receive for a work-related injury or illness?
When you suffer a workplace accident, the compensation process should be simple and straightforward. There are certain benefits, rights and responsibilities for workers in the event of a workplace accident or personal injury. In Georgia, employers have an obligation to keep employees safe. However, many businesses in Georgia and their insurance companies place revenue above the safety of their employees and their due benefits if injured.
In many cases, workers and their families are left in a financial crisis because insurers delay approval for surgery and other crucial medical treatment, or their workers’ compensation benefits are outright denied even when they’re unable to work because of their injuries.
Here’s what you need to know about Georgia’s workers’ compensation and your medical benefits.
How does Georgia workers’ compensation work?
In Georgia, workers’ compensation insurance is required for all businesses with 3 or more employees, whether or not those workers are full or part-time. Every person is covered by workers’ compensation insurance, whether you’ve been at the job for a single day or 50 years.
To qualify for compensation, you must meet the following requirements under Georgia law (O.C.G.A. 34-9-81.1):
- Follow written rules of safety and policies of your employer.
- Report the accident immediately or no later than 30 days after the incident occurred.
- Report the accident to your employee, employer representative, supervisor, foreman or human resources.
- Accept medical treatment and rehab services if ordered by the State Board of Workers’ Compensation.
- Show that the incident wasn’t a result of the employee’s willful misconduct.
- Notify the insurance company under your employer with your address and when you’ll be able to return to full-time or part-time work.
- Notify any change of address to the insurance company.
- File a claim within 1 year after the day of last authorized medical treatment or within 2 years of your last paycheck from weekly benefits.
- File a claim with the State Board of Workers’ Compensation within a single year after the death of your loved one due to the workplace incident.
- Submit a request for reimbursement of any mileage or expenses related to medical care.
- Submit to a drug test following the incident (if required).
You should be honest and truthful when filing a workers’ compensation claim. If you are not telling the truth, you could be found guilty of making false statements and claiming benefits unlawfully.
What medical expenses are covered by workers’ compensation?
If you have suffered a workplace injury, you can receive compensation for all of your injuries, including medical expenses and missed pay. For families of loved ones who have died due to a workplace incident, you may also be entitled to financial benefits.
Here is a list of medical expenses covered by Georgia’s workers’ compensation:
Diagnostic tests
All x-rays and MRIs are covered as they are necessary to determine what your condition is and the severity.
Emergency room visits
If you are taken to the emergency room as a result of your work-related injury, then your medical expenses are covered under Georgia law.
Alternative treatments
Acupuncture, biofeedback and other naturalistic medications are not included in compensation coverage. Western medication and standard treatment at approved hospital facilities, however, will likely be covered by workers’ compensation. You may file an appeal to have alternative treatments covered, but this process can be difficult.
Prescriptions
Once your treatment plan is established by your doctor, any prescriptions related to your work injury are covered through Georgia workers’ compensation. However, they must be prescribed in relation to your injury.
Follow-up doctor visits and limits to ongoing care
In most cases, physical therapy, chiropractor therapy and massage are long-term care options related to movement limitations, back pain, joint pain and other ongoing ailments in relation to your workers’ compensation claim. There is a time limit to this treatment, but it can be extended with a recommendation from your doctor. You’ll need to work with a claims representative to prove that you need ongoing care.
Travel expenses to medical visits
You can file for compensation for travel to and from doctor’s visits, diagnostic tests and other medical treatment related to your workplace injury. However, you’ll need to prove with receipts and mileage to prove that the money is rightfully being used to travel to appointments only related to your injury.
Does workers’ compensation pay for fatal injuries in Georgia?
In Georgia, employers are required to pay the expenses of an employee’s burial up to $7,500. In addition, the employee’s spouse and dependents are also entitled to a weekly compensation equal to 2/3 of the weekly income that they would have received up to a maximum of $675 per week.
However, some employers try to skip out on paying death benefits by claiming the death is not “compensable” under the same act. This means that a spouse would have to show that the death resulted instantly from an accident on the job or that the worker died later as a result of the injuries sustained on the job. This is where a lawyer is extremely helpful in proving your case.
When does workers’ compensation start to pay medical benefits?
After you open a workers’ compensation claim, the insurance company will start to pay your bills immediately and continue to pay them as you receive more treatment.
What are the caps on workers’ compensation in Georgia?
If you are receiving weekly compensation in Georgia, there is a cap that stipulates you cannot receive more than $675 per week. However, if you are on a temporary disability, which means you are able to work but can’t earn the same amount, then you receive 2/3 of the difference between your average earnings. These benefits cap out at $450 per week.
Filing a workers’ compensation claim and receiving the benefits you’re owed can be a complicated and time-consuming process. It’s best to hire the services of an experienced and trained attorney to handle these matters so that you can focus on healing.
