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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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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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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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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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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.”
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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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Workers are constantly forced to multitask, particularly when it comes to juggling their personal and professional lives. Unfortunately, trying to be efficient cost one home health care nurse in Ohio the right to collect workers’ compensation benefits, following a decision by the Ohio Supreme Court in Friebel v. Visiting Nurse Ass’n of Mid-Ohio. carcrash2.jpg

The court ruled against the “dual intent” doctrine, which would have allowed a worker running a personal errand while on his or her way to the next assignment to collect benefits for a crash that occurred at that time.

Although the decision doesn’t directly affect workers in Georgia, we can rest-assured courts will review this case when similar questions arise.
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Georgia workers’ compensation injury claims are rarely straightforward, even when it’s clear injury occurred in the scope and course of employment.
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This is especially true with regard to temporary total disability benefits when a worker quits, is fired or is laid-off for reasons unrelated to the injury.

Temporary total disability (TTD) benefits are those designed to help workers recover lost income when they are unable to work due to a job-related injury. Workers qualify if they cannot do the kind of work they did before because of the accident. If an employee is deemed entitled to collect temporary total disability benefits, those may continue until:

  • He returns to work
  • His doctor says he can return to work
  • His doctor says he has permanent disability that is not expected to improve (at which point you can seek permanent disability benefits)
  • More than 400 weeks have passed since the injury (unless injuries are catastrophic, in which they case benefits could continue indefinitely)

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The Georgia Supreme Court has upheld the constitutionality of a provision of the Workers’ Compensation Act that precludes non-dependent parents from recovering benefits following the death of an adult child killed in the course of employment.
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In Barzey v. City of Cuthbert, plaintiff argued the provision violated her constitutional rights to equal protection and due process. The state supreme court disagreed, finding the law was sound, even though it left plaintiff with virtually no means of monetary recovery for her son’s death.

Workers’ compensation, the court reasoned, is established to allow exclusive remedy to an employee’s heir’s for the worker’s death during the course of employment, and the act expressly states that compensation for the death of a worker is to be payable only to dependents, and even then, only during dependency.
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After filing a workers’ compensation claim in Georgia, there may be other avenues of compensation available. These include third-party lawsuits, which can be brought against anyone from manufacturers of defective products to owners of a construction site where an injury occurred.
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In some situations, third-party lawsuits may be brought against co-workers if it can be shown their negligent actions were proximate cause of your injuries. However, there is one key point that must be proven in order to bring a claim in these cases. It will need to be proven the co-worker was acting outside the scope of his or her employment at the time he or she caused the injury.

The Georgia Supreme Court set this precedent rather recently in the 2012 case of Smith v. Ellis, reversing the precedent set previously by the Court of Appeals ten years earlier in Ridley v. Monroe. The principle question in Smith was whether a worker who files for – and receives – workers’ compensation in exchange for a no liability settlement with his employer is then allowed to turn around and sue the co-employee who caused the injury. The appellate court had answered “No” in Ridley, holding OCGA 34-9-11(a) bars such recovery because the employee has already obtained relief. The state supreme court held that while Ridley was correctly decided, and workers are barred from collecting compensation from co-workers acting within the scope of employment at the time of an accident, they may pursue damages from a co-worker as third-party if the co-worker was acting outside the scope of employment.
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The Georgia Legislature recognized that when workers are injured on-the-job, they are entitled not only to receive adequate compensation, but also to obtain those benefits in a timely manner. In order to give employers incentive to comply, lawmakers passed a provision of OCGA 34-9-221 that allows for injured employees to seek the imposition of statutory penalties for late benefits payments.
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Specifically, the law states benefits must be paid weekly, with the first becoming due on the 21st day after employer has knowledge of injury or death and has to be paid via electronic transfer. Payments that are not paid when due automatically accrue a 15 percent late penalty. Payments that are more than 20 days late accrue a 20 percent late fee.

These late penalties are payable not to the state but directly to the injured worker. However, that injured worker needs to file a claim for benefits, and it helps to have an experienced workers’ compensation lawyer. Also, it’s important to make those claims within a timely fashion. Otherwise, as the recent case of Marta v. Reid illustrates, the opportunity may be forever lost.
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