December 17, 2014

Qualifying for Benefits

In Georgia, there are many questions to consider for understanding whether an injured employee qualifies for Workers' Compensation benefits. An employee who is injured in an on the job accident is faced with the tough battle of healing as well as complex legal issues that are difficult to deal with while recovering. The first step in any claim is to be certain that the employee is eligible for benefits.

qualifying-benefits.jpgThe first question to answer is whether the employee was injured during working hours at his/her place of employment. Sometimes, an employee is injured in a car accident while traveling for their employer. Other times an employee might be loaned from one employer to another. What about the employee who works from home? These are all questions that must be answered as the first step when making a claim.

It is very important for the employee to notify the employer of his injury as soon as possible. Failing to notify the employer can result in non-payment of benefits. This does not mean talking with a co-worker about the accident. A person in a supervisory position must be notified. This notification must take place within one year of the accident date.

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December 15, 2014

Problems with Your Employer

For an employee, one of the most difficult aspects of a Workers' Compensation claim is communicating with their employer about their injury. Many times the injured worker is not comfortable speaking with their employer because they are afraid of angering their boss, saying something that will prevent them from getting their benefits or being fired from their job. In the worst case scenario, the worker's injuries are so severe that they cannot communicate with their employer at all.

Problems-with-Employer-275.jpgTalking with an employer is not easy when you have been injured. The employer might take the position that the employee has not been injured at all, but is only faking the injury in order to get out of work. This often happens with injuries that do not cause broken bones or more severe injuries, but with soft tissue injuries such as back strains. In these cases, it is very important to have a medical examination so that a doctor can support your claim.

Another problem that often happens is that your employer will tell you something entirely different than the insurance adjuster tells you regarding your claim. The insurer is paid by the employer, so you would think that they would advise you in the same way. However, there are times when they disagree with their instructions. The employee is left not knowing what to do and in a state of confusion.

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December 12, 2014

Uninsured and Self-Insured Employers

In Georgia the law requires that employers have Workers' Compensation insurance coverage if the Employer has three or more employees. All too often, employers fail to purchase Workers' Compensation coverage. When this happens, the injured employee is in real need of legal representation.

Uninsured-Employer.jpgWhen an employer fails to have Workers' Compensation insurance coverage, the employee can request a hearing with the State Board. In this hearing, the employee can request to be awarded medical expenses that are injury related, weekly income benefits, attorney's fees, penalties and even criminal prosecution.

Ironically, the injured worker cannot sue the uninsured employer in civil court. In Georgia, Workers' Compensation is the "exclusive remedy" for an injured worker. This means that the injured worker cannot file a lawsuit against the uninsured employer. Instead, the injured worker must file a claim with the State Board of Workers' Compensation. This is the only method that the employee has to collect benefits, when filing a claim becomes necessary.

There are times when an employer is self-insured. This means that the employer has agreed to pay for Workers' Compensation claims out of pocket rather than buying an insurance premium. However, there are strict guidelines for an employer to follow when declaring themselves self-insured. If these guidelines are not followed there are legal ramifications for the employer.

Filing a claim against an uninsured employer is a difficult task for most injured workers. Many times it is hard to get the information that you need from your employer. Sometimes employers will refuse to give out any information to an employee. This results in the employee being delayed in receiving income benefits and from getting the medical treatment that they need.

How can you determine whether your employer has insurance? We are here to help you with your claim and to answer any questions that you may have. For more information contact us: J. Franklin Burns, P.C. - 1-404-303-7770.

December 12, 2014

In re Essex Ins. Co. - Work Amputation Victim Fights for Insurance Coverage

It is an unfortunate reality that far too many employers and insurance companies in Georgia prioritize profits over people. Even in cases where a worker has suffered a devastating and lifelong injury, it's not uncommon for these entities to deny claims for coverage, forcing the worker to engage in litigation for rightful compensation.
In the recent case of In re Essex Ins. Co., before the Texas Supreme Court, employer and insurer are trying to avoid paying compensation to a man who lost his arm while operating a tortilla machine.

The company didn't have workers' compensation coverage, but it did have a general liability policy. Both the worker and the company say he was an independent contractor - not an employee - which the insurance company disputes. This point hasn't yet been resolved, but the state supreme court ruled the worker has to prove the tortilla company is liable for the injury before he can pursue a separate claim against the insurance firm.

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December 10, 2014

Offer of Suitable Employment

In some Workers' Compensation claims in Georgia, there may come a time when the Authorized Treating Physician approves a job that he or she believes that the worker can perform. Typically, the doctor will be given a job description by the insurance adjuster that will include the physical requirements that are necessary for the new job. When this happens, the Employer/Insurer will make what is known as an offer of suitable employment to the employee.

suitable-employment.jpgThis offer must be made in writing to the employee with a description of the job to be performed, the hours to be worked, and the rate of payment. The notice must also include the location of the job, with the date and time that the employee is to report for work. The authorized treating physician must have evaluated the employee within sixty days prior to the offer of employment. The Employer/Insurer must also file forms with the State Board that the employee was notified at least ten days before the date the employee was required to report for work.

Failing to report to work will most likely result in the suspension of the employee's income benefits. But, what happens when the employee shows up for work? The employee must attempt to perform the job duties for eight cumulative hours or one scheduled work day, whichever is longer. If the employee does not stay on the job for that period of time, the employee's payment of income benefits may be suspended.

If the employee attempts to do the job offered, but cannot continue for more than fifteen scheduled work days, the employer/insurer must reinstate their income benefits. If the Employer/Insurer fails to reinstate the income benefits, they give up their defense that the job offered was suitable employment for the period of time the Employer/Insurer did not pay the weekly income benefits.

If you have been offered suitable employment or have concerns regarding this issue, please contact us. We are here to help. J. Franklin Burns, P.C., at 1-404-303-7770.

December 8, 2014

Car Accidents While On the Job

Many employees must travel as a part of their job requirements. Sometimes injuries result from car accidents while traveling for business purposes. Workers' Compensation benefits are payable, depending on what the employee was doing at the time of the collision.

car-accident.jpgTraveling to meetings or to make sales calls would be an accepted claim. Making deliveries and running errands for a supervisor or boss would also be an accepted claim. Operating a motorized vehicle, such as a semi-truck would be a payable claim. If you get into a car accident while traveling to and from work, in most cases the injuries would not be accepted as a Workers' Compensation claim.

An issue arises in on the job car accidents when another party is at fault. When there is insurance coverage under the Employer's Workers' Compensation policy and also a liability insurance policy from the at-fault driver's insurance the benefits are coordinated very carefully. There is a possibility that the injured worker will have both a Workers' Compensation claim and a Personal Injury claim in civil court.

Filing a Workers' Compensation claim for injuries resulting from car accidents can insure that medical bills and income benefits will be paid. However, in Georgia, a Workers' Compensation claim does not pay for pain and suffering due to injuries. In civil court, making a claim for pain and suffering would be possible. Likewise, the Workers' Compensation insurance carrier would not pay for property damage to your car. These damages would be paid by the automobile liability insurance carrier.

An employee who is injured on the job in an automobile accident must be very careful not to sign away his rights by settling with one insurance carrier before settling with another. The settlement documentation with either claim must be carefully worded and must consider the claim that is not yet settled. This is a tricky area of the law and one in which it is always wise to have professional representation.

If you have been injured in a car accident while on the job, please contact us right away. Let us help you decide the best course of action for you. J. Franklin Burns, P.C., at 1-404-303-7770.

December 6, 2014

Auto Owners Ins. Co. v. All Star Lawn Specialists Plus - Defining Employee Versus Independent Contractor

Although workers' compensation law varies from state to state, there is one general principle that remains fairly consistent: Exclusive remedy. This holds that if an employee is injured or killed while working and his employer carries workers' compensation insurance, the only damages he may collect from his employer is workers' compensation.
There are, of course, options for third-party liability lawsuits and social service benefits for long-term disabilities. But in general, workers' compensation will be the only money collected from an employer and/or an employer's insurer in these instances.

However, an exception can be made when the company did not carry workers' compensation insurance coverage, or when the individual making the claim was not an employee. Independent contractors have no right to collect workers' compensation coverage, and therefore may pursue litigation. Sometimes, this issue is straightforward. Bear in mind, though, just because a company labels a worker an "employee" does not necessarily make it so. When there is a dispute, courts will weigh a host of factors, such as the degree of control a company had over the worker's duties and method of payment.

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December 5, 2014

Being Watched: Surveillance in a Workers' Compensation Claim

Injured workers in Georgia are often subjected to surveillance by a private investigator hoping to "catch" them with pictures or on video doing something that will help the insurer to cut off the employee's benefits. These private investigators are working for the insurance company on a regular basis. Their goal is to be able to suspend or cut off your Workers' Compensation benefits.

surveillance.jpgAnytime that an injured worker is outside of their home, there is a good chance that a private detective is watching. Simple things such as taking the trash out, bending to pick up something in the yard, carrying and putting a child into a car, or picking up a delivery package from the porch can be captured by the investigator.

When an injured worker leaves home there is also a great chance that there is a private investigator watching to see if the injured worker will do something to compromise their claim. Running errands, driving, visiting friends, eating out in restaurants and even going to church are all times when the investigator may be working to try and catch the injured worker doing physical activity that is prohibited by the doctor.

The insurance company often knows where the injured worker is going to be. After all, the insurance adjuster is the one who makes doctor appointments and schedules medical tests for the injured worker. The private investigator could be waiting in any parking lot, shopping in the same pharmacy, or even sitting in the same doctor's office as the injured worker.

It is of extreme importance to stay within the restrictions that have been ordered by the authorized treating physician. Sometimes even an innocent movement can be distorted to make the injured worker look as if they are faking their injury. It is best to be cautious at all times. If the injured worker is photographed or caught on tape the claim for Workers' Compensation benefits may be seriously compromised.

For more information on surveillance of injured workers and any other questions that you have about Atlanta work injury compensation, contact J. Franklin Burns, P.C., at 1-404-303-7770.

December 1, 2014

Don't Jeopardize Your Benefits

Even though your benefits may have begun for your Workers' Compensation claim, this does not mean that they are guaranteed to continue. There are many ways that an injured worker may lose his entitlement to benefits. As an injured worker, it is a good idea to educate yourself about how your benefits could be suspended, or cut off.

One way that an injured worker can lose his entitlement to benefits is by failing to report his or her Workers' Compensation claim promptly and in a timely manner. Even if you are unsure, you should speak with your supervisor or employer about your injury. In Georgia, if the claim is not reported before the one year anniversary from the date of injury, the right to benefits is lost.

jeopardize-benefits.jpgIf you fail to cooperate with your employer or your authorized treating physician, your benefits may be compromised. What does failure to cooperate mean? It does not mean that you have to do anything and everything that your employer tells you to do. It does not even mean that you have to agree with all your authorized treating physician's recommendations for medical treatment. For example, in Georgia you have the right to refuse recommended surgery. However, it does not mean that you can disobey the Workers' Compensation laws at random. It is often very difficult to know whether your choices are going to jeopardize your benefits, even when the issue seems simple enough.

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November 30, 2014

Presley v. Dalton Logistics: Extraterritorial Workplace Injury Issues

In this global economy, it is not uncommon for workers to contract with businesses in one state and then conduct work in another.
Almost all work-related injuries in Georgia are going to fall under the Georgia Workers' Compensation Act. However, when a worker based in Georgia or working for a Georgia-based firm is injured in another state, that can complicate matters.

It's known as an "extraterritorial workplace injury," and the question of whether or not Georgia law will apply, as opposed to the workers' compensation laws of the state where injury occurred, will depend on several factors. The issue can be an important one, as states can vary with regard to interpretations of key definitions like "work-related" and "independent contractor," and may vary with regard to statutory limitations.

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November 28, 2014

GA State Board of Workers' Compensation Rule 205

In Georgia, the State Board of Workers' Compensation is the governing body that makes the rules and regulations that are applied to Workers' Compensation claims. One of these rules is Rule 205. This rule states that a doctor or medical provider does not have to get advanced permission to treat the injured worker before rendering services. The treatment does have to be injury related for the rule to apply.

wc205-1.jpgIn most cases, the doctor or medical facility will request authorization for treatment and testing. The Employer/Insurer has 5 days to respond to the request. Most medical providers send in a form to the insurance company asking for permission to give treatment. They do this so they can be sure to be paid. The rule states that the insurance company or the self-insured employer has to respond to the doctor or medical facility within 5 business days of receiving the form. If the insurance company or self-insured employer does not respond, the treatment by the doctor or medical facility is considered authorized and the doctor or medical facility must be paid by the Employer/Insurer.

Recently, the Georgia Supreme Court addressed Rule 205. One of the issues was the burden of proof. The burden of proof means which side has the obligation to prove a fact in court. The Court of Appeals held that the burden of proof was improperly shifted to the employer and insurer to prove that a claim was compensable or payable in situations regarding medical treatment and testing. In Georgia, proving whether or not a Workers' Compensation claim is payable is always the burden of the employee. In other words, the worker must prove that his claim is payable in Georgia Workers' Compensation claims.

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November 24, 2014

What About Expenses in a Georgia Workers' Compensation Claim?

Naturally, being unable to work is going to place you in a financial bind while your injury is healing. Expenses can add up. In Georgia, some of these expenses may be covered by the Employer/Insurer. Others may not be covered, so it is good to know just what expenses might be reimbursed to you.

expenses.jpgIf you drive or ride in a personal vehicle to and from your doctor's appointments, the mileage will be reimbursed to you at the rate of 56.5 cents per mile. If you take public transportation those expenses may be reimbursed. Expenses for taxis to and from medical appointments may also be reimbursed. In certain situations, meals and lodging may be reimbursed to you. For example, if your medical appointments take you away from home and require you to spend the night in a motel this may be an expense that will be reimbursed. These expenses are covered only if they are deemed necessary and appropriate in order for you to receive quality medical care.

In situations where expenses may be reimbursed, it is important for you to be a good record keeper. Save receipts and keep a log of your odometer readings with the dates that you traveled. Without receipts and good records, you most likely will not be reimbursed by the employer/insurer. It is very important that you submit documentation of your approved expenses within a year's time of incurring the expenses. Otherwise, your right to reimbursement is lost.

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November 21, 2014

Medical Treatment in a Georgia Workers' Compensation Claim

In Georgia, employees who are injured on the job are entitled to Workers' Compensation medical benefits. These benefits include medical treatment that is necessary to cure you, provide pain relief, or restore your health so that you can return to suitable employment.

medical-treatment.jpgOne of the issues that every injured worker faces in their Georgia Workers' Compensation claim revolves around medical treatment. After an authorized treating physician has been assigned to the claim, it is very import for the injured worker to be involved in their treatment and to follow the advice of their medical providers.

Georgia law requires that an injured worker cooperate with their doctors and therapists when at all possible. While recommended surgery may be rejected without fear of compromising the claim, failing to follow the doctor's advice can have a negative effect on the claim. It is especially important to keep appointments and to follow up with medical providers on the schedule that they recommend. But, what happens when the injured worker is not satisfied with their medical treatment?

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November 20, 2014

Benavides v. Eastern N.M. Med. Ctr. - "Wet Floor" Sign Absence Results in Higher Award

Every state has varying rules when it comes to workers' compensation law, but most provide that workers' compensation is a no-fault system and employers generally cannot face negligence litigation. cautionwetfloor.jpg

That means workers don't have to prove negligence in order to collect benefits, but neither can they sue the employer for negligent acts or omissions resulting in injury.

However, there are sometimes penalties for companies that fail to adhere to relevant state, federal and industry safety codes. These can come in the form of fines from the Occupational Safety & Health Administration. In New Mexico, it can result in a 10 percent higher amount of workers' compensation benefits paid to injured workers.

That was the issue argued in Benavides v. Eastern N.M. Med. Ctr., where an injured nurse argued that lack of a "wet sign" floor in the slick hallway of a hospital where she work constituted lack of a safety device.

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November 11, 2014

Trezza v. USA Truck Inc. - Injury Not Compensable Minutes After "Logout"

In order for injuries to be compensable under worker's compensation law, they either need to occur while working or "arise out of the scope and course of employment."
For most who work at stationary offices, the question of what is compensable and what isn't is fairly straightforward, though there is always the potential for complexity in certain circumstances. However, the waters are often muddier for workers whose jobs are not stationary.

A good example of this was recently seen in the case of Trezza v. USA Trucking Inc., before the Arkansas Supreme Court. Although this is an out-of-state case, it's relevant here in Georgia, as there are thousands of licensed commercial truckers in this state.

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