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Workers’ Compensation | What is workers’ compensation and what does it pay for?

Posted by Samuel C. Rumph | Mar 04, 2016 | 0 Comments

Almost 11,000 people are hurt on the job every day across the United States, and 13 people go to work and never come home according to the United States Department of Labor's Occupational Safety and Health Administration (OSHA).  This translates into almost 4 million employees suffering from sort of work place injury every year.  For the injured worker, this means a loss of income and medical expenses that need to get paid.

Workers' compensation is accident insurance paid for the employer.  The Georgia Workers' Compensation Act is what governs who has to have this insurance, when it pays, what it pays, and how long it pays.  It is required insurance for any employer with three or more employees (full or even part-time).  You are covered from day one on the job. This insurance provides you with medical care, rehabilitation and income benefits.  These benefits are provided and designed to help you return to work as quickly as possible.  Even if you are fired or terminated, it does not prevent your right to recover.  You should report any accident occurring on the job to your employer (boss, foreman, or supervisor) immediately.  If you wait longer than 30 days, you may lose your right to obtain benefits.


What exactly is meant by “accident causing injury”? Many employees are aware that workers compensation covers a sudden traumatic event such as when they pick up something too heavy, get hit by something on the job or where they experience a fall.  But most employees are unaware of what is known as a “repetitive motion injury” (also known as a “cumulative trauma injury,” “repetitive action injury,” or “repetitive stress injury”).  This occurs when the employee performs some type of repetitive motion that is unique to their job.  This includes things like:  1) where a job requires the employee to walk a 1300 step spiral stairway 3 times a day causing a disabling knee condition requiring surgery; 2) where a water meter man has to bend over 300 times a day to read meters causing significant and premature lower back problems; and 3) a worker who performs the same repetitive motion with her hands and arms that develop severe injuries, like carpal tunnel syndrome.  In none of these cases will there likely ever be a single traumatic event that started their pain.  Rather, these kinds of problems can take months if not years to develop into a debilitating and disabling condition.

Typically, in these latter situations like these the employees are told they didn't get hurt at work and are advised to file under their group health insurance which allows employers to avoid workers' compensation claims.  However, in these cases if the employee is ever terminated, he or she will likely lose their health care coverage and regardless is never compensated for their loss of income.

However, even after you report an accident obtaining these benefits is often times not easy.  Since your employer is paying for medical treatment, the employer has some control over where you can go to get medical treatment.  Georgia law allows them to control this by making available a list (panel) of doctors, or by using a workers' compensation managed care organization (WC/MCO) which includes a 24 hour hotline for you to call for assistance.  In either situation, once you select one of the doctors you can only change one time and still receive covered medical treatment, without help from an attorney.  You should know also that just going to your own doctor will almost always result in a denial of covered medical care.  Then, in order to get income benefits (a percentage of your lost wages), one of these approved doctors must take you out of work or so limit your physical activities that it results in some sort of documented loss of income for at least seven days.

Regardless, even if the WC insurer pays for either medical treatment or income benefits initially, maintaining eligibility is problematic.  The insurer is always looking for reasons to shorten or reduce your recovery.  Many times disputes arise between one of the doctors provided by the employer and you regarding what work restrictions you have regarding your ability to work.  Also, many times the insurer will deny or delay medical treatment recommended by the doctor.  Getting proper documentation to preserve these benefits can be difficult.



About the Author

Samuel C. Rumph

Partner- Complex Litigation Sam is an experienced trial attorney and engineer. As the managing partner for his law firm he has been a driving force for office automation, innovation and efficiency. It was this relentless quest that led Sam and his law partner Jeff to develop a cutting edge case ...


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