Your Workers’ Compensation Benefits in a Nutshell

Most people have established a routine of working, earning an income and paying the bills to make their ends meet. However, when you are injured on the job and can no longer work, everything immediately changes. How do you meet your financial obligations? In Georgia, your employer is not obligated to hold your job while you recover from your injuries. In such cases, you can file a Workers’ Compensation claim to receive benefits for your medical expenses, lost wages and a permanent impairment rating.

The Workers’ Compensation program provides financial assistance for lost wages and the medical costs of a person who has sustained an on-the-job injury, develops job-related disease or leaves dependents when a worker is killed in a job-related accident. These benefits protect employees and their families from suffering financial destitution after a work-related injury or death. Lost wage benefits or disability benefits are usually paid out weekly or biweekly. Workers’ Compensation benefits also include payment of medical expenses and permanent partial disability benefits for a permanent impairment to compensate the victims of job-related injuries. Prior to the establishment of a Workers’ Compensation program, an employee had to file a lawsuit against their employer. Often, these lawsuits could be costly and difficult to win. After the passage of the Workers’ Compensation Act in Georgia in 1920, an employee could no longer sue his employer, but could file a claim for workers’ compensation disability and medical benefits. Today, the workers’ compensation program benefits both the injured employee by providing for timely payment of disability and medical benefits, and the employer by providing protection against excessive lawsuits and verdicts.

Workers’ Compensation as a program began to appear in the United States in the early 1900s and today is the longest-running social insurance program. Most employers have a Workers’ Compensation insurance policy in place to cover the benefits for any employees injured on the job. The program itself is managed by the state, which ensures that benefits are paid and disputes are resolved.

At Affleck & Gordon, we have obtained millions of dollars in benefits for our clients, saving you the hassle of trying to understand the complex law in this area. During our over thirty years of practice, we have represented workers’ against big corporations and insurance companies, who try to limit the compensation allowed to injured employees.

Injured employee’s rights under the Workers’ Compensation Act include:

  • The cost of medical treatment and/or rehabilitative therapies.
  • Death benefits paid to your dependents.
  • Medications and/or other costs associated with your recovery, including travel expenses to and from the doctor.
  • Vocational rehabilitation training if you are unable to return to your previous position and you qualify for such benefits.
  • Weekly income benefits if you miss more than seven days of work.
  • Catastrophic Injury – you are entitled to two-thirds of your average weekly salary up to the maximum allowed for as long as you are unable to return to work.
  • Non-Catastrophic Injury – you are entitled to two-thirds of your average weekly salary up to the maximum allowed up to 400 weeks of temporary total disability benefits, or up to 350 weeks of temporary partial disability benefits.
  • Catastrophic injuries included paralysis, amputations, blindness, severe head trauma, spinal cord injury or any injury severe enough to keep you from returning to your past work or any other work.

Your employer is required by law to post a list of at least six doctors or a certified Workers’ Compensation Managed Care Organization providing medical care to any injured employee. You are allowed two selections of treating physicians from this panel of doctors without prior approval of the insurance company or State Board of Workers’ Compensation. Any additional changes require approval of the insurance company or the State Board. In cases where emergency treatment is needed, different rules may apply.

Your Top 5 Social Security Disability Questions Answered

1.      What is the Difference  between Social Security disability and SSI disability?  SSI disability stands for “Supplemental Security Income” disability. This is a program that does not require you to have paid into the Social Security program. However, this program is income based. Social Security Administration (SSA) looks at what income you have coming into the household. This would include the income of your spouse, any part-time income, and any other source of income, such as from workers’ compensation, VA disability, income from investments, rental income etc.
You can also obtain SSI payments if your Social Security disability gross check is usually under $800 (an estimate in which you need to check with SSA to determine what is the cutoff amount each year). There is also a resource requirement in which after excluding the home you live in and one car your remaining resources don’t exceed $2000 if you’re single or $3000 if you’re married.
The definition for disability is essentially the same for both programs. Currently, the maximum amount SSA sends out for a disabled SSI recipient is around $735. This can change based upon each year’s cost of living changes. Oftentimes SSA will take applications for both benefits because at the time of the application there is financial eligibility since one has not been approved for Social Security Disability benefits at the time of the SSI application.

2.      What Does “Date Last Insured” Mean on Your Denial? For individuals that are applying for Social Security  Disability benefits based upon their work record you must satisfy certain earning requirements. Generally, you must have one quarter of coverage for every year since age 21 up through the date in which you are claiming to be disabled. Most filers meet this requirement. However, an additional requirement is that you must have 20 quarters of coverage during the 40 quarter period ending with the date you claim to have become disabled. For instance, let’s say a woman worked from age 21-31, then had children and started back to work at age 40. She completed only 4 years of work and then became unable to work due to her disability. In that instance she would not have had 20 quarters of coverage (five years of coverage) in the 40 quarter period (10 year period) ending with her becoming disabled. This woman would have only obtained 16 quarters (four years) in the ten year period SSA looks at. Note, there are ways to obtain additional quarters of coverage through part-time work to become insured. For more information call Affleck and Gordon’s Social Security Disability Attorneys at 404-373-1649.

3.      How Much Will Your Monthly Social Security Disability Benefit Be? Generally, SSA sent out your earnings record to you each year that you are working up until 2011 or you can go online and see it at www.1.usa.gov/1d3xvuZ. In 2014, SSA resumed mailings at 5-year intervals to workers who hadn’t signed up for online statements. So, at age 25, 30, 35, 40, 45, 50, 55, 60, you’ll still get an earnings statement. SSA gives an estimate as to how much you would receive if you became disabled or retired. The amount you receive is based upon what you paid into the Social Security system indexed by inflation. However, what you can receive can be offset by IRS tax liens, non-payment of child support, bankruptcy liens, workers’ compensation, etc.

4.      How is it that Some People You know got Approved with Less Disabilities than You Have? A variety of factors are used by SSA in determining if someone is disabled. They look at the age of the person, their education, and their prior work experience over the last 15 years. For example, a person who is 50 years of age or older who has never done sedentary or primarily seated work with lifting under 10 pounds on an occasional basis, and does not have any skills obtained from their work history that could be used for sedentary work,  and is now reduced to sedentary work only will ordinarily be found disabled. Thus, if a person over 50 years of age  was a receptionist and was limited to sedentary work, SSA would find that person not disabled since their work history included sedentary work, whereas if that person had been a grocery store stocker, which is not sedentary work, that person would be found disabled if now restricted to sedentary work. The same theory would apply for restrictions to light duty work for individuals 55 years of age or older that due to their disabilities are reduced to light duty work (lifting no more than 20 pounds occasionally). The issue of transferable skills can be crucial in many of these determinations where one is capable of doing more than unskilled work.

5.      If You are Unable to Work due to Conditions that Improve, can You Still get Disability Benefits? If you have a condition or a number of conditions that have each  lasted 12 months or longer, SSA will look at the combination of your impairments to see if they singly, or in combination, prevent the ability to work. If they do, then you could be found disabled. However, if there is improvement in any of these conditions that would suggest to SSA that you have regained the ability to work, then SSA can find that you are entitled to a “Closed Period” of disability beginning with the date you became disabled and when said condition(s) improved to allow you to return to largely full time work. Ordinarily, SSA will pay an additional 2 more months of benefits following the month in which disability ended. If SSA had already found you disabled and your improvement began after you began receiving benefits, then SSA will at some time conduct a continuing disability review to see if your benefits should be continued. Please keep in mind that if you had returned to work, you were supposed to let SSA know about this.