If you’re an injured worker, you may be left wondering how you’ll pay for medical costs or make up your prior wage benefits. If your employer is a workers’ compensation carrier, workers’ compensation benefits can give you peace of mind as long as your injury occurred on the job. Georgia’s workers’ compensation law structure is fairly straightforward. If you’re unsure whether you qualify for workers’ compensation in Georgia, a Sandy Springs work injury lawyer at Ashenden & Associates can help you determine your rights and if you are, in fact, qualified for workers’ comp insurance.
Here, we cover exactly what qualifies for workers’ compensation in Georgia.
Georgia Workers Compensation Laws
Understanding Georgia workers’ compensation requirements is key to determining eligibility. In Georgia, employers with at least three employees are required to carry a workers’ compensation policy, typically provided by an insurance company authorized to sell workers’ compensation insurance. This policy ensures benefits for those injured while performing work-related duties.
We cover Georgia workers’ compensation laws and what qualifies for workers’ compensation in Georgia in detail below.
Who is Eligible for Workers Compensation in Georgia?
Full-Time Employees
Workers employed on a full-time basis by companies with three or more employees are covered under Georgia workers’ compensation laws.
Part-Time Employees
Part-time employees working for employers with at least three employees are also eligible to receive workers’ compensation benefits for an on-the-job injury.
Seasonal Workers and Temporary Employees
Seasonal employees and temporary employees hired by an employer with valid workers’ comp coverage may qualify for workers’ compensation benefits, provided the employee’s injury occurs during their employment and while performing assigned duties.
Employees of Small Businesses (Meeting Threshold)
Workers employed by small businesses with at least three or more employees are eligible for workers’ compensation benefits under Georgia workers’ compensation laws.
Employees in High-Risk Industries
Workers in industries such as construction, manufacturing, and healthcare are typically covered under workers’ comp insurance if the employer complies with state requirements.
The most common workplace injuries in Georgia related to the construction industry often require more than Georgia workers’ compensation benefits can offer. If you’re an injured worker whose accident was caused by third-party negligence, our Sandy Springs construction accident lawyers can help determine if filing a personal injury lawsuit would provide more financial recovery.
Corporate Officers or LLC Members
Corporate officers or LLC members who do not opt-out of their worker’s compensation insurance company are included under workers’ compensation insurance.
Workers Injured While Traveling for Work
Employees injured while performing work-related tasks offsite, including travel for business purposes, are eligible for workers’ compensation claims.
Employees Performing Job Duties
An injured employee who suffers an on-the-job injury while performing assigned tasks within the scope of their employment is covered under workers’ compensation in Georgia.
Employees Experiencing Repetitive Stress Injuries
Any injured employee who develops repetitive stress injuries, such as carpal tunnel syndrome, due to their job duties is eligible for workers’ compensation benefits.
Employees with Work-Related Illnesses
Workers who develop occupational diseases or illnesses as a direct result of their employment may file a workers’ compensation claim.
Catastrophic Injury Victims
An injured worker who experiences a catastrophic work-related injury, such as paralysis or traumatic brain injuries, are eligible for extended workers’ compensation benefits under Georgia law. However, in Georgia, many times, the workers compensation insurance company policy will fall short of fully covering the medical costs, even to get to maximum medical improvement.
Our Sandy Springs catastrophic injury attorneys help injured employee clients seek compensation that fully covers all medical expenses, including home and vehicle modifications that Georgia workers’ compensation benefits do not cover.
Surviving Dependents
In the event of an employee’s death due to a work-related injury, dependents such as spouses or children are eligible for death benefits and funeral expense coverage.
Eligibility is determined based on the employment relationship, the scope of the worker’s duties, and compliance with Georgia workers’ compensation laws. Understanding these criteria ensures employees and employers navigate the system effectively.
Who is Not Eligible for Workers Compensation and Special Circumstances
Understanding who qualifies for workers’ comp in Georgia and the exclusions under Georgia’s workers compensation law is essential for employees and employers. While most workers are covered by workers compensation insurance, certain groups are excluded under Georgia workers’ compensation laws, leaving them ineligible to receive workers compensation benefits.
Here’s a comprehensive breakdown:
Independent Contractors
Independent contractors are typically excluded under Georgia workers’ compensation law because they are not considered employees. However, if a contractor is misclassified and functions as an injured worker under the control of the same employer, they may have grounds to file a workers’ compensation claim for workers’ compensation coverage.
Domestic Workers
Domestic workers, such as nannies and housekeepers, are not covered by workers’ compensation in Georgia unless the employer voluntarily provides workers’ compensation insurance coverage. These workers are not eligible to receive workers’ compensation benefits for a workplace injury or work-related injury without proper workers’ compensation coverage.
Farm Workers and Farm Laborers
Many farm workers and farm laborers are excluded from Georgia workers’ compensation requirements, leaving them unable to file for workers’ compensation benefits unless their employer chooses to carry workers’ comp insurance.
Employees of Small Businesses
Under Georgia’s workers’ compensation laws, employers with fewer than three or more employees are not required to carry workers’ comp insurance, leaving these workers without access to workers’ compensation benefits for an on-the-job injury.
Federal Employees
Federal employees are excluded from state programs under the Georgia Workers’ Compensation Act. Instead, they are covered under federal laws, meaning they cannot file workers’ compensation claims with the Georgia State Board of Workers’ Compensation.
Volunteers
Volunteers are generally ineligible under Georgia workers’ compensation laws, as they are not classified as employees.
Seasonal Workers
Seasonal employees generally qualify for workers compensation in Georgia, provided their employer meets the legal requirement of having at least three employees. If seasonal employees are injured while performing their job duties, they may be eligible for workers’ comp coverage, which includes benefits for medical care benefits, income benefits for wage replacement, and disability benefits.
However, eligibility for seasonal employees can depend on factors such as the duration of employment, the nature of their work, and whether the employer carries a valid workers’ compensation policy.
Some employers may attempt to classify seasonal workers as independent contractors, which could affect their ability to file a workers’ compensation claim. Ensuring workers’ comp coverage for seasonal employees helps provide financial support and medical benefits for those injured on the job, just like their full-time counterparts.
Self-Employed Individuals
Self-employed individuals and sole proprietors are not automatically covered under workers’ comp insurance. They must purchase their own workers’ compensation policy from a workers’ compensation insurance carrier to ensure coverage for work-related injuries.
Casual or Temporary Workers
Workers hired for one-time or occasional jobs unrelated to industrial activities often do not qualify for workers’ compensation benefits under Georgia workers’ compensation requirements.
Injuries Outside Scope of Employment
If the employee’s injury occurs outside the scope of their job duties, such as during commuting or recreational activities, it is not considered a work-related injury and does not qualify for workers’ compensation in Georgia.
Intentional Misconduct or Illegal Acts
Injuries caused by intoxication, illegal drug use, or violations of company policy are excluded from workers’ comp coverage under Georgia law. Similarly, self-inflicted injuries are not covered.
Specific Federal and Industry Exceptions
Railroad workers, maritime employees, and some specialized workers are excluded from Georgia workers’ compensation law because they are covered under federal programs instead.
Addressing Disputes
If eligibility is disputed, cases may be reviewed by an administrative law judge through the State Board or the Georgia State Board of Workers’ Compensation, depending on the circumstances. Ensuring compliance with Georgia’s workers’ compensation requirements and understanding exclusions is crucial for both employers and employees navigating the workers’ comp system.
What Work-Related Injuries are Covered By Georgia Workers Compensation Benefits
- Work-related injuries
- Occupational illnesses
- Repetitive stress injuries
- Catastrophic injuries
What Is Not Covered By Workers Compensation in Georgia
- Injuries caused by intoxication or drug use
- Self-inflicted injuries
- Injuries occurring during unauthorized activities
Medical Treatment Requirements for Georgia Workers Compensation Benefits
To qualify for Georgia workers’ compensation benefits, the injured employee must adhere to specific medical treatment requirements as outlined by Georgia’s workers’ compensation laws. Georgia workers comp laws ensure that employees receive appropriate medical treatment while maintaining compliance with the workers’ compensation insurance system.
- Authorized Treating Physician: The injured worker must select an authorized treating physician from the employer’s approved panel of physicians or a managed care organization (MCO). This physician oversees all medical care related to the injury, including referrals to specialists.
- Employer-Provided Panel of Physicians: Employers are required to provide a panel of at least six doctors, including one orthopedic specialist. Workers must choose their authorized treating physician from this panel to ensure coverage of medical expenses under Georgia workers’ compensation law.
- Reasonable and Necessary Treatment: Only treatments deemed reasonable and necessary for the recovery of the work-related injury or illness are covered. This includes doctor visits, surgery, therapy, medications, and diagnostic tests.
- Compliance with Treatment Plans: The injured employee must comply with their physician’s treatment plan, attend appointments, and follow prescribed rehabilitation to maintain eligibility for benefits.
- Requesting a Change in Physician: If the injured employee is dissatisfied with their initial doctor, they are entitled to one free change of physician within the approved panel or with approval from the Georgia State Board of Workers’ Compensation.
- Travel Reimbursement: The injured worker is reimbursed for travel expenses related to their medical treatment, including mileage to and from medical appointments, at the state-approved reimbursement rate.
By following these medical treatment requirements, the injured worker can ensure his or her medical costs and related expenses are covered while protecting their eligibility for wage replacement and other workers’ compensation benefits.
Georgia Workers’ Compensation Managed Care Organization vs Georgia Board of Physicians
In Georgia, Managed Care Organization creates the plan under the Georgia Workers’ Compensation Act. In a workers comp case, the Managed Care Organization is the only judge if injured workers’ employers select this option for medical treatment.
With the board of physicians, an authorized treating physician from a board of approved physicians examines the injured employee to determine how serious the work-related injuries are. Under Georgia workers’ compensation law, only two of the authorized treating physician group can be from an industrial clinic. Georgia’s workers’ compensation law also requires at least one authorized treating physician to be from a minority or protected class.
Georgia Workers Compensation Benefits
Medical Benefits
Injured employees in Georgia are entitled to receive medical benefits to cover all necessary and reasonable medical expenses related to their workplace injury or illness. These benefits include coverage for medical care, surgery, medications, and physical therapy until the employee reaches maximum medical improvement (MMI), which is the point where further recovery is not expected. The employer’s workers’ compensation policy also covers medical costs such as hospital stays and authorized specialist visits to ensure proper care for employees who receive medical benefits.
Weekly Wage Benefits
Georgia workers comp coverage provides weekly wage benefits to replace lost income for employees unable to work due to a job-related injury. These weekly wage benefits are calculated based on two-thirds of the injured worker’s average weekly wage, up to the state-mandated maximum. Weekly income benefits ensure injured employees receive financial support up to their prior average weekly wage during recovery, with wage replacement payments continuing as long as they remain eligible under income benefits under Georgia workers’ compensation coverage.
Indemnity Benefits
Indemnity benefits compensate an injured worker for lost wages during their recovery. These payments ensure financial stability for employees who are unable to work due to their injury, covering the gap created by their inability to perform job duties.
Permanent Disability Benefits
If an injury results in lasting impairment, employees may qualify for permanent partial disability benefits. These benefits compensate workers for their long-term inability to perform certain tasks or maintain full earning capacity due to their injury. The amount and duration depend on the severity and classification of the disability.
Temporary Partial Disability Benefits
For employees who can return to work in a limited capacity but earn less than their pre-injury wages, temporary partial disability benefits are available. These benefits provide partial compensation for the difference between the worker’s reduced earnings and their previous wages, helping bridge the financial gap during recovery.
Death Benefits
If an employee dies due to a workplace injury or illness, their dependents may receive death benefits under Georgia workers’ compensation coverage. These benefits include weekly payments equal to two-thirds of the deceased worker’s average weekly wage, up to the state maximum, as well as funeral and burial expenses. Dependents, such as a surviving spouse or minor children, rely on these payments for financial support after the loss of a loved one.
Georgia Workers Compensation Statute of Limitations
In Georgia, the workers’ compensation statute of limitations sets strict timeframes for filing a workers’ compensation claim. Injured workers must file a claim with the State Board of Workers’ Compensation within one year from the date of their injury. If the employer has provided medical treatment or weekly income benefits, the timeframe may be extended, allowing the claim to be filed within one year of the last medical treatment or within two years of the last payment of weekly benefits. For cases involving a change in condition after receiving benefits, workers have two years from the last payment to file for additional benefits. Failing to meet these deadlines can result in the loss of the right to compensation.
The Role of the Georgia State Board of Workers’ Compensation
The Georgia State Board of Workers’ Compensation plays a vital role in administering and enforcing the state’s workers’ compensation laws. Its primary responsibilities include overseeing the claims process, ensuring compliance with legal requirements, and protecting the rights of both employees and employers.
Key Functions of the Georgia State Board of Workers’ Compensation
Workers Compensation Claims Administration: The Georgia State Board of Workers’ Compensation manages the filing and processing of workers’ comp claims, ensuring that injured workers receive medical benefits and wage replacement in accordance with state laws.
Dispute Resolution: The Georgia State Board of Workers’ Compensation resolves disputes between employees, employers, and insurers through mediation and formal hearings. If conflicts cannot be settled, an administrative law judge presides over the case to make a ruling.
Compliance and Enforcement: Employers are required to carry workers’ compensation insurance, and the Georgia State Board of Workers’ Compensation enforces compliance with this mandate. Non-compliant employers may face penalties or sanctions.
Education and Resources: The Georgia State Board of Workers’ Compensation provides guidance and resources to help workers, employers, and insurance providers understand their rights and obligations under Georgia’s workers’ compensation system.
Appeals Process: If any party disagrees with a ruling on a workers’ compensation claim, the Georgia State Board of Workers’ Compensation oversees the appeals process to ensure fairness and proper application of the law.
The Georgia State Board of Workers’ Compensation ensures that the system operates efficiently, ensures injured employees are receiving workers compensation benefits they are entitled to while maintaining fairness for the workers compensation carrier.
Georgia Workers Compensation Settlements and Payouts
In Georgia, workers’ compensation settlements and payouts are financial agreements designed to compensate injured employees for work-related injuries or illnesses. Workers’ compensation settlements typically include medical benefits, average weekly wage replacement, and other associated costs, providing financial stability to employees unable to work due to their injuries.
Workers’ compensation settlements are negotiated agreements between the employee, the employer or workers’ compensation insurance carrier, and the insurance company. In Georgia, workers’ compensation settlements may include a lump-sum payment or structured payouts over time, depending on the terms agreed upon. Settlements are often reached when the employee’s condition stabilizes or reaches maximum medical improvement, meaning no further recovery is expected.
Workers compensation settlements for employees that qualify for workers’ compensation in Georgia include:
- Medical Benefits: Includes past and future medical care related to the injury.
- Wage Benefits: Wage replacement is based on the worker’s average weekly wage.
- Permanent or Temporary Partial Disability Benefits: Payment for temporary or permanent partial disability.
- Vocational Rehabilitation Services: Occupational and physical therapy to help get a new job if the employee cannot return to their previous role.
Employees may opt for a settlement if they prefer a lump sum over ongoing benefits or if disputes arise with the employer or insurance company regarding the claim. A settlement finalizes the workers’ comp case and often waives the worker’s right to future workers’ compensation benefits, so careful consideration is crucial. Negotiating a fair settlement for workers’ compensation in Georgia can be complex, especially when dealing with an insurance company. Consulting an experienced workers’ compensation attorney ensures that the injured worker’s rights are protected.
Approval by the Georgia State Board of Workers’ Compensation
All settlements must be approved by the Georgia State Board of Workers’ Compensation to ensure fairness and compliance with state laws. This step ensures that the worker is fully informed about the terms of the agreement before it is finalized.
Workers’ compensation settlements in Georgia provide financial security and closure, helping families move forward after an employee’s injury.
How a Sandy Springs Workers Compensation Attorney Can Help
Navigating workers’ compensation claims in Georgia can be overwhelming, especially when dealing with the insurance company or disputes about eligibility. A workers’ compensation attorney in Sandy Springs can guide you through every step of the process, ensuring your rights are protected under Georgia workers’ compensation laws.
Our attorneys help injured employee clients file an accurate workers’ compensation claim, negotiate workers’ compensation settlements, and ensure they receive all available workers’ compensation benefits, including medical benefits, weekly income benefits, and death benefits for dependents. If your employer or workers’ compensation insurer denies your workers comp claim, our team can represent you in hearings before the Georgia State Board of Workers’ Compensation or assist with appeals.
Additionally, we advocate for injured employees who need further support, such as vocational rehabilitation services or fair compensation for returning to a lower-paying job after their recovery. Whether you are dealing with a complex workers’ comp case or seeking coverage from a reluctant workers’ comp insurance company, our firm is here to provide expert guidance tailored to your situation.
Contact our Sandy Springs law firm today for compassionate and experienced assistance in your workers’ compensation claim.
