When you have sustained a serious work injury and your injury is determined to be “catastrophic” under Georgia workers’ compensation laws, then you are entitled to medical benefits, vocational rehabilitation benefits and Total Disability Benefits indefinitely or until you can return to work. If your injury is not specifically labeled as catastrophic, your income replacement benefits will be capped at 400 weeks. This is why it’s important to ensure you receive a catastrophic injury determination under Georgia workers’ compensation rules.
Eligibility Requirements for Catastrophic Determinations
O.C.G.A. 34-9-200.1(g) provides the state’s definition of catastrophic. The following injuries are considered catastrophic in a workers’ compensation claim:
- Spinal cord injuries that involve severe paralysis of the arm, leg or trunk
- Amputation of an arm, hand, foot or leg that results in the effective loss of use of that appendage;
- Severe brain or closed-head injuries (To be considered severe, the employee must have severe sensory or motor disturbances, severe communication disturbances, severe complex integrated disturbances of cerebral function, severe disturbances of consciousness, or severe episodic neurological disorders.);
- Second- or third-degree burns over 25 percent of the body as a whole;
- Third-degree burns to 5 percent or more of the face or hands; and
- Total or industrial blindness.
In addition to the above specific conditions, the law stipulates that your condition still may be deemed as catastrophic if the injury is “of a nature and severity that prevents the employee from being able to perform his or her prior work and any work available in substantial numbers within the national economy for which such employee is otherwise qualified.”
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Proving Your Injury is Catastrophic
Given the vague nature of some eligibility requirements, there is some leeway in what types of conditions and the severity of the symptoms that qualify a worker for a catastrophic determination. If you or your loved one sustained a severe work-related injury, you’ll want to have a lawyer review the case to see if you should pursue catastrophic workers’ compensation benefits.
When a worker suffers a workplace injury or a work-related accident, the injured worker is often entitled to workers’ compensation for their lost wages, medical expenses and more. Georgia, as a general rule, has a no-fault workers’ compensation system, meaning that neither party needs to be found at fault in order for the injured worker to seek workers’ compensation benefits. Since it is a no-fault system, workers are not able to sue their employers for any work-related injuries that they may suffer, but workers can sue third parties who are responsible for causing their work-related injuries.
For the purposes of workers’ compensation claims, workplace accidents are categorized as either catastrophic or non-catastrophic for the purposes of workers’ compensation benefits. The worker’s treating physician generally can issue the determination as to whether the worker’s injuries are catastrophic or non-catastrophic. The treating physician must evaluate the injuries and must make their designation in accordance with the law. The employer or insurance company can also agree with the injured worker’s lawyer as to the designation of the injuries. Furthermore, the Georgia State Board of Workers’ Compensation can designate a worker’s injuries as catastrophic. However, an injury designation can change over time. For instance, if the worker’s treating physician gives approval that the worker can return to work, then the worker’s designation can be changed from catastrophic to non-catastrophic.
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Catastrophic Workers’ Compensation Cases
Catastrophic workers’ compensation cases involve workplace accidents that are very serious. Workers are seriously injured in catastrophic cases and generally are unable to return to their job in the same or similar capacity after their work-related injuries. Examples of catastrophic injuries include:
- Amputation of a limb – This can include amputation of a foot, hand, arm or leg and can include the resulting loss of use of that limb.
- Severe paralysis – Paralysis can be in an arm, leg or other appendage and the loss of use of that appendage.
- Spinal cord injuries – Spinal cord injuries generally produce paralysis to some part of the body.
- Severe head injuries – Closed head injuries can result in all kinds of difficulties with the brain. Loss of sensation, difficulty with motor skills, and problems with communicating, reasoning or decision making can all be byproducts of a head injury.
- Severe brain injuries – Serious brain injuries can severely inhibit a worker.
- Severe burns – Second and third degree burns that cover more than 25 percent of the body, or third degree burns covering more than five percent of the face and hands are considered catastrophic in nature.
- Blindness – Blindness can be total blindness or industrial blindness, meaning loss of vision to the point that the worker can no longer do his or her job.
- Other injuries that are so serious that they prevent a worker from performing his or her previous job tasks, or the job tasks of a number of jobs in the economy.
Workers who are the victim of a catastrophic workplace accident are entitled to two thirds of their normal weekly salary under workers’ compensation, but weekly wage compensation is capped at $550 a week. Workers with catastrophic injuries are also eligible for medical, vocational, and rehabilitation benefits as they recover from their injuries. These workers are eligible for workers’ compensation benefits for life.
Workers who suffer catastrophic injuries are entitled to Temporary Total Disability benefits for the duration that the worker is unable to go to work. Upon returning to work, the Temporary Total Disability benefits will no longer be paid to the worker. However, if a worker is only able to return to the workforce in a position that is lower paying and less skilled than his or her prior position because of the effects of his or her catastrophic workplace injuries, the worker is eligible for Temporary Partial Disability benefits. These workers could later also become eligible for Permanent Partial Disability benefits, after the Temporary Partial Disability benefits are paid.
Employers are required to appoint a rehabilitation supplier for all workers who suffer catastrophic injuries. This individual should have experience handling catastrophic workers’ compensation cases, and will help the injured worker get the care he or she needs.
Non-Catastrophic Workers’ Compensation Cases
All other work-related injuries that are not so serious that they are considered catastrophic, are considered to be non-catastrophic workers’ compensation cases. Worker generally are able to return to work at some point after recovery, but it may not be in the same capacity as before when they suffered their work-related injuries.
Workers who are the victim of a non-catastrophic workplace accident are entitled to ⅔ of their normal weekly salary under workers’ compensation, but weekly wage compensation is capped at $550 a week. Workers who have suffered non-catastrophic worker-related injuries are eligible for up to 400 weeks’ worth of weekly compensation benefits under workers’ compensation.
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Why You Need a Workers’ Compensation Lawyer
When a worker gets a catastrophic designation, it is important to work closely with a workers’ compensation lawyer to ensure that the designation goes unchallenged. Workers’ compensation insurers often fight claimants on their workers’ compensation claims in order to avoid paying, or in order to pay less than they should. In particular, these insurers are notorious for disputing whether an injury designation as catastrophic is appropriate. The insurers dispute catastrophic designations because these are often the most costly workers’ compensation claims that the insurers pay for. When workers’ compensation insurers are being unreasonable, a skilled Atlanta workers’ compensation lawyer can help ensure that you get the appropriate designation for your injuries and can assist with any disputes that arise with the workers’ compensation insurer.
Bader Scott Injury Lawyers: Contact an Atlanta Workers’ Compensation Lawyer
Workers who suffer workplace injuries need help and compensation as they recover from their injuries. The Atlanta workers’ compensation legal professionals at Bader Scott Injury Lawyers are dedicated to helping Atalanta workers in obtaining the workers’ compensation that they need. Whether your injuries are catastrophic or non-catastrophic, we can help you with your workers’ compensation claim. Contact us today.