Georgia Workers Compensation Basics

In Georgia, every employer who has three or more employees, whether full time or part time is required to carry workers compensation insurance. There are some exceptions – work comp coverage is elective for planning commissions, partners, sole providers, licensed real estate agents and brokers, agricultural and domestic workers. All county and municipal governments and all school districts must carry workers compensation insurance.

To obtain workers compensation coverage in Georgia, the employer has two options which are:

1. purchasing a workers compensation insurance policy from a state approved insurance company

2. qualifying as an approved self-insured employer and posting a surety bond or a letter of credit with the state

The employee must report the injury to the employees supervisor within 30 days of the occurrence. The employer is required to file the Employers First Report of Injury form, WC-1 with the Georgia State Board of Workers Compensation. If the employer fails to file the WC-1, the employee can report the claim to the Board of Workers Compensation by filing state form, WC-14, Notice of Claim.

The employer must provide a list / panel of at least 6 doctors (at least one doctor must be an orthopedist) for the employee to select from. If the employer fails to post a panel of doctors for the employee to choose from, the employee is allowed to select his own doctor. The employee has the right to switch one time to another doctor on the panel. A unique aspect of Georgia law is the employee who is being paid indemnity benefits can demand a “claimants independent medical examination” by the a doctor of the employees choice (i.e., employee’s attorneys choice) within 60 days of the start of indemnity benefits, paid for by the work comp insurance company.

All authorized medical care and associated expenses (prescriptions, prostheses, mileage reimbursements) are covered by workers compensation. All billing of medical services by medical providers must be in compliance with the Georgia Workers Compensation Medical Fee Schedule, which is updated on April 1^st of each year.

The temporary total disability (TTD) benefits are calculated as two-thirds of the employees average weekly wage over the 13 weeks prior to the date of injury, not counting the week of the injury. The maximum amount of TTD benefits that can be paid weekly is changed by the Georgia Legislature from time to time. There is no automatic cost of living increase. The maximum TTD benefits per week for injuries are $500.00 per week. The state minimum weekly benefit is $50.

The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 21 days. TTD benefits can be paid for a maximum of 400 weeks.

In Georgia, the employee will receive TTD benefits as long as the employee is off work from the injury (up to 400 weeks). If the employee is able to return to any type of work, but at a lesser rate of pay then the amount the employee was earning prior to the injury, the employee is entitled to temporary partial disability (TPD) benefits. The TPD benefits are paid at two-thirds of the difference between the pre-injury wage and the post-injury wage. The TPD benefits are paid for up to 350 weeks from the date of injury. The TPD benefits plus the post-injury pay rate can not exceed the state’s maximum indemnity benefits rate.

Georgia employees are paid permanent partial disability (PPD) benefits for any permanent disability suffered as the result of an on-the-job injury. Once the employee has reached maximum medical improvement, the authorized treating doctor assigns a disability rating based on the American Medical Association Guidelines. Georgia uses a schedule of injuries for limbs, vision and hearing. The loss of an arm or leg is worth 225 weeks of indemnity benefits (with a week calculated the same as TTD). The schedule decreases as the size of the limb decreases with a small toe being worth 20 weeks. A person with an injury to body as a whole is worth up to 300 weeks of indemnity benefits. For example, if the treating doctor gives the employee a 10% disability rating to the back, and the employees TTD rate was $500 per week, the employee will receive $15,000 ($500 X 300 X 10%).

Georgia permits the employee to collect a maximum of 400 weeks of indemnity benefits for all types of indemnity combined, unless the employee is classified as having a catastrophic injury which is defined as:

1. Spinal cord injury causing paralysis to an arm, leg or trunk

2. Amputation of an arm, leg, hand or foot involving the effective loss of use of the body part

3. Severe brain injury

4. Second or third degree burns over 25% or more of the body, or third degrees burns to 5% or more of the face or hands

5. Total or industrial blindness

6. Any other injury that prevents the employee from being able to work (employees attorneys love this one)

If the employees injury is designated as a catastrophic injury, the employee can draw indemnity benefits for life.

Death Benefits:

The burial expenses in Georgia are covered for a work-related death up to $7,500. The death benefits for a dependent spouse and children follow the same guidelines as TTD benefits – two-thirds of the average weekly wage – currently a maximum of $500 per week, up to a maximum of 400 weeks, except there is a dollar maximum for death benefits in the amount of $150,000. If there is no spouse or dependent children (includes step children and adopted children), death benefits can be paid to dependent parents, college students and disabled adult children.

Georgia workers compensation law also includes rehabilitation benefits / vocational benefits. If the injured employee is unable to return to their prior job due to disabilities from their on-the-job injury, Georgia requires the employer / insurance company to pay for the cost of retraining the injured employee to perform another job. In addition to job retraining, vocational benefits include:

9. Vocational evaluation

10.Vocational counseling

11.Psychological testing and evaluation

12.Job analysis and job modification

13.Job placement

Vocational rehabilitation is in the best interest of the employer, the employee and the insurance company as placement in a new job reduces or eliminates the amount of TPD that will be paid, and stops the employee from making a claim for catastrophic indemnity benefits.

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