Most types of income benefits are capped at a certain number of weeks. You will receive income benefits until your condition improves or as determined by the schedule of permanent partial disability benefits for specific body parts. There is an exception to this rule. If your injury is determined to be “catastrophic,” Georgia workers’ compensation laws let you receive lifetime income benefits.
Four Main Types of Workers’ Compensation Benefits
Workers’ compensation benefits generally fall into one of four main categories. These include:
- Medical care
- Temporary disability
- Permanent disability settlement
- Vocational rehabilitation
Employees are entitled to medical treatment from a doctor or medical facility that is part of the workers’ compensation insurance network. Your employer should provide you with the names of medical facilities or physicians where you can receive treatment. You should not have to pay for medical costs out-of-pocket.
If you are unable to work for a period of time following the injury, you are entitled to temporary disability payments. A temporary disability is one that keeps you out of work for more than seven days. Then you are entitled to compensation for the entire time that you are out of work while you recover from the injury.
If your injury is severe enough to cause you to be unable to work, you may be entitled to permanent disability benefits. Once your medical treatment has gone as far as it can go, you may still not be able to return to work. In some cases, you may lose some function in your limbs or back. In this situation, you may be provided permanent disability payments. The payments are designed to provide you with the money you should have received if you were still able to work.
If your injury no longer allows you to return to your original type of work you did prior to the accident, you may be entitled to vocational rehabilitation. This training will give you the knowledge and expertise to find employment in a different line of work if your employer has no other employment opportunities available.
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Vocational Rehabilitation Benefits
O.C.G.A. 34-15-1(D)(13) defines vocational rehabilitation services as “any service, provided directly or through public or private instrumentalities, found by the director to be necessary to compensate a person with disabilities for his or her disability to employment and to enable such individual to engage in a remunerative occupation.”
Below are some examples of the types of vocational rehabilitation benefits an employer may offer:
- On-the-job training for new roles and tasks;
- Vocational evaluations;
- Career counseling;
- Job placement services, including resume building and interview coaching;
- Transferable skills analysis and job testing;
- Labor market surveys;
- Refresher courses;
- Educational programs;
- Consulting potential employers about job accommodations and modifications;
- Assessing potential new positions for ergonomics; and
- Education and tuition payments for retraining.
These types of vocational services are crucial to workers whose new disability prevents them from working in the same capacity as they once were able. Your employer should provide these services at no cost to you.
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Employee Responsibilities for Rehabilitation Services
Just as the employer is required by law to offer vocational rehabilitation services, you are required to use them. You must make a good faith effort to learn new skills and find new work, despite your disability. This is in the best interests of both the employer and the worker. If you fail to comply, you’ll put your workers’ compensation benefits in jeopardy.
What happens to benefits when you use vocational rehabilitation services?
Many injured employees are concerned that their income replacement benefits will stop if they undergo vocational rehabilitation. If you are catastrophically injured, you will receive temporary total disability (TTD) benefits until your condition improves or until you can return to the workforce. If you earn less in your new position than you earned in your old job, then you will begin receiving temporary partial disability (TPD) benefits in lieu of TTD.
Your TPD payment will amount to two-thirds of the difference between your weekly wage prior to your injury and new weekly wage at your new position.
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Requirements for Lifetime Income Replacement Benefits
In order to be approved for lifetime income benefits, there must be sufficient medical evidence to support the fact that you are catastrophically injured and cannot work. The Georgia State Board of Workers’ Compensation Employee Handbook explains that to receive a catastrophic determination, the injury must prevent “the employee from being able to perform his or her prior work and any work available in substantial numbers within the national economy.”
Below are a few common examples of catastrophic injuries:
- Severe paralysis;
- Severe head or brain injuries;
- Severe burns; and
- Industrial blindness.
Calculating Lifetime Income Replacement Benefits
Within Georgia workers’ compensation laws, there is no mention of the term “lifetime income benefits.” Rather, these types of benefits are labeled as temporary total disability benefits (TTD)a misnomer because employees with catastrophic injuries can receive these benefits indefinitely if their conditions never improve.
If your authorized treating physician has deemed you unable to work, your weekly benefit amounts to two-thirds of the average weekly wage you made at the time of the injury. In most cases, your average weekly wage will be calculated by taking an average of the past 13 weeks of active employment. For instance, if you were making $600/week on average before your injury, your TTD check will amount to $400. The maximum amount of TTD allowable in Georgia is $525, as of July 1, 2013.
If your injury is not catastrophic, the maximum amount of time you can receive TTD is 400 weeks. If an injury is catastrophic, then O.C.G.A. § 34-9-261 stipulates that the injured worker will receive TTD “until such time as the employee undergoes a change in condition for the better.”
In addition to lifetime income benefits, if you were catastrophically injured on the job, you are also eligible for lifetime medical benefits and vocational rehabilitative services.
Calculation of Benefits
The “average weekly wage” is the starting point for all calculations of benefits. It is applied, and then further applied to the sliding scale based on the impact of the injury as well as its categorization. The principle is to try to and compensate you for disability and to keep your earnings as close as possible to what they might have been without the injury. The calculator will compute the average wages from the last 13 weeks preceding the incident which led to the injury. The calculation will incorporate the basic salary/wage as well as any allowances (clothing, lodging, meals etc.), tips, and year end bonuses.
The average weekly wage is a double-edged sword in as far as it can reduce or increase your overall earnings depending on what you were doing in the 13 weeks prior to the injury. For example you could be at a disadvantage if in those last 13 weeks, you have reduced your work time or earned fewer tips than usual. Those that were hurt on the very first day of their job will obviously not have the 13-week window to use as a baseline. Hence the calculator will use a comparative analysis based on the earnings of an employee in a similar position to yours.
Temporary Total Disability Benefits
Those whose injuries result in total disability are entitled to TTD. This figure is calculated at two-thirds of average weekly wage, but can be no more than $500 per week for any incident that occurred on or after the 1st July 2007. Those that occurred prior to that date are not capped as long as they are within the two thirds rule. You can only get TTD for 400 weeks since the date of the injury. The only exception is if your injury has been deemed to be catastrophic in nature. Examples of catastrophic injuries include brain injury; paralysis; severe neurological disorders; amputation (leg, foot, arm and hand); and total blindness.
Consult with an attorney in order to confirm whether your injury falls within this category within the meaning of the Georgia laws. For example, you do not have be completely physically disabled in order to meet the threshold for “disability from work.” This is because the law considers whether the impairment significantly reduces your ability to engage in your job. A case in point is where you are able to do light work but your employer is unable to or unwilling to accept you as you are. This is a situation where you may still be entitled to TTD.
Temporary Partial Disability Benefits
If you are impaired but not totally disabled from work, you may be entitled to TPD. The principle purpose of TPD is to compensate you because you are no longer able to earn the level of wages that you expected per week based on your work. The calculation is that you get two-thirds of the difference between your average weekly wage before and after the injury. However TPD is capped at no more than $334 per week. Your employer is required to pay TPD even when you are now employed with a different organization. TPD can be collected for no more than 350 weeks.
Permanent Partial Disability Benefits
The payment of PPD is dependent on the level of physical disability. It does not focus on earning capacity like the other types. Hence you are able to get PPD even if you have never missed a single day of work or lost any wages due to the incident. PPD is calculated based on the percentage of impairment. This determination requires the professional opinion of a doctor and not your employer. It also considers the part of the body which has been impaired and your earnings prior to the incident. One of the conditions of PPD is that it does not begin until the TTD or TPD payments are exhausted.
Penalties for Late Payments
Employers are penalized at 15 percent of the outstanding balance if you do not get any of your benefits on time. The penalty does not remove the unpaid debt. A case in point is if the employer has incorrectly denied you a benefit that you are entitled to for a period of time. Another applicable case is if they miss a payment altogether or send it late.
You are not entitled to any cash benefits for the first seven days following the incident unless the injury has lasted for at least 21 consecutive days. The seven days can be paid back in arrears if the incapacitation period exceeds 21 consecutive days.
Consulting a Workers’ Compensation Lawyer in Atlanta
For questions about your workers’ comp case or for information about the types of benefits that might be available to you, call Bader Scott Injury Lawyers, today at (404) 888-8888.