Worker’s Compensation: What benefits am I entitled to?

By: Zack Hendon | Posted on: November 10, 2015 9:00 am

Today we’re talking about workman’s compensation and what benefits you would be entitled to.

What medical treatment am I entitled to? Can you give me an example or two?

You’re entitled to medical treatment for your injury. There is no deductible, whereas with your health insurance you might have deductible, you might have to either meet a deductible, and then you have to meet some copay. There’s no deductible, and there’s no copay on the expenses for medical treatment.

There is a requirement, generally, that you treat with an authorized treating physician or a authorized referral physician. If you’re seeing a particular doctor and he might refer you out to a neurologist, that might be an authorized referral physician. If you do seek treatment with authorized medical staff, then it’s covered so long as it’s a incontestable claim – a claim that’s not been controverted.

If it is a non-catastrophic case, meaning your run-of-the-mill worker’s comp case, a foot injury or a back strain or something like that, then it is limited to 400 weeks of medical treatment. Within the last couple of years, the law has changed; it used to be lifetime medical.  Now a catastrophic case, for example, a person that’s had his leg cut off in an accident, there is no 400 week cap on medical treatment.

So, that’s an outline of the medical benefit.

What about disability payments?

If you’re hurt so badly that you cannot work, then in the authorized treatment position either takes you out of work or puts you on light duty. If the employer maybe doesn’t have light any work for you to do, so that you would not be entitled to a wage, you would then be entitled to disability payments.

By way of example, let’s say, if you’re average weekly wage is $600 a week, then you’re entitled to 2/3 of that average weekly wage or in this case would be $400 of disability payments. For a non-catastrophic case, those payments can continue for up to 400 weeks, and for a catastrophic case it could continue for lifetime.

Lifetime, is that moving into permanent disability? Is that different from a permanent disability settlement?

You can have a permanent disability even in a non-catastrophic case. The third type of benefit in worker’s comp is the PPD rate, which is the permanent partial disability rate.

What happens is, if it’s a catastrophic case and your indemnity is being paid throughout your entire life, and if you never get off your indemnity benefits, you really never received a PPD settlement, because the benefits never cease.

If you have a scenario, and it can either be because you’ve gone back to work or because you’ve exhausted your 400 weeks of indemnity benefits, then, once you’re disability payments cease, your permanent partial rating can start to be paid out.

What is a permanent partial rating?

What that is, is in Georgia, the law says you’re entitled to a PPD rating, and what that means is the authorized treating physician is supposed to take the AMA Guides to Permanent Impairment, 5th Edition, and use the rating tables in there. These books are two volume set of books, very large books, covering every body part, and the doctor is supposed to use those books to develop a rating.

Now, in general, what really happens is that you have these orthopedic surgeons that are used to giving these ratings; I don’t think they really go to the books. For example, if you’ve got a herniated disk in your back, some of the employer friendly doctors are used to giving a 10% rating, or if you have a back surgery with a fusion, they might give you a little bit more. A lot of times, these rating books say that the rating should be a lot higher than some of these employer friendly doctors give you.

What will happen in a permanent disability rating, let’s say for example, that you’ve had back surgery and the doctor gives you a 10% rating. Well, the law says that on certain types of body parts (and they’re listed in the code section), if it’s a listed body part, it tells you how many weeks for 100% rating.

For things like back or neck injuries, those are considered whole body ratings, and in Georgia a whole body rating is 300 weeks. So if the doctor says, “Okay, you’ve got a back injury, I’m going to give you a 10% rating,” that is translated to say 10% of those 300 weeks. Then the adjuster multiplies the 10% by the 300 weeks and that entitles to you an extra 30 weeks of benefits. This is the same comp rate that you were getting when you were on total / out of work, or what we call TTD – Temporary Total Benefits.

The example I gave before is a person making $600, then gets a $400 a week benefit, it works the same. In this example, a person with a 10% rating to the back would get 30 weeks at $400 a week until that’s paid out.

Typically, when we are trying to get a case settled, what we’re doing is we’re putting together and forecasting those three benefits and  what’s going to happen in the future. When we put together that, we then tell the adjuster, say, “We’ll settle our case for X number of dollars, based on our forecast of these three events,” that’s the medical, the disability and the PPD rate.

What about vocational rehabilitation?

Years ago, like twenty years ago, even in non-catastrophic cases you had vocational rehabilitation or voc rehab for short. The law changed so that now you only have voc rehab in catastrophic cases and you do not have it in non-catastrophic cases. Sometimes nurse case manager can be on the file if you give them permission, and they can sometimes help an employee find a job, but in general there is no voc rehab unless it’s a catastrophic case.

If you need help, give Zack Hendon a call.

Zack Hendon wants to make sure that you are educated about topics that effect you. He just explained what your benefits are and what you’re entitled to in workman’s compensation and now that you have it, what do you do? Zack Hendon is an attorney here in Metro Atlanta with the Hendon Law Firm, and if you’re in the metro Atlanta area and you need help, be sure to give him a call at (770) 284-3737

Disclaimer: information purposes only. Zack is an attorney with over 30 years experience, and provides this information to help you, but this cannot be seen as legal advice. For legal advice, you need to have a consultation with an attorney in your area. If you’re in the metro Atlanta area, please give the Hendon Law Firm a call.

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