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If you sustain an injury at work in Georgia you may be entitled to “income benefits”, permanent disability benefits and medical benefits. Question: What are the workers’ compensation benefits in Georgia?
In order to qualify for income benefits, you must be off work for seven consecutive days. There are two types of income benefits in Georgia: TTD (temporary total disability) and TPD (temporary partial disability).
What is Temporary Total Disability or TTD?
If you are deemed completely unable to work, you may be entitled to TTD benefits. TTD income benefit calculations use 2/3 of your average weekly wage for 13 weeks prior to your date of accident. However, there is a statutory maximum for injuries. Also, prior to July 1, 2013, this was $500 per week. So, this amount is not taxed. As a result, if your injury is not deemed “catastrophic” by the State Board of Workers’ Compensation, you could be entitled to TTD benefits for up to 400 weeks from the date of the original accidents. In reality, most cases settle prior to this limit if the injury is not catastrophic.
What is Temporary Partial Disability or TPD?
TPD benefits may be owed to you if you suffer a wage loss due to your work injury. Today, there are several methods used to calculate TPD benefits and it can get complicated. However, if you were injured and returned to work at a lesser paying job, you may be entitled to TPD benefits for up to 350 weeks from the date of the original accident. Also, you will need to keep very good records of your post-accident wages if you believe you may be entitled to TPD income benefits. O.C.G.A. Section 34-9-261 and 262 outline the TTD and TPD payment procedures.
What is Permanent Partial Disability or PPD?
PPD benefits may be owed if the Authorized Treating Physician finds that you have sustained some permanent impairment as a result of the work injury. Consequently, he physician typically assigns a “PPD rating” which is then multiplied by a certain number. That number is then the number of weeks PPD benefits are owed and the final PPD amount is determined by taking the number of weeks multiplied by your workers’ compensation weekly income benefit rate. The insurance company can pay this amount weekly or in a lump sum. Also, you are not entitled to PPD benefits if you are receiving TTD or TPD benefits.
The impairment ratings follow AMA Guides, however, I often see doctors “guesstimate” a rating with no basis. The insurance company is also supposed to request a PPD rating from the doctor within 30 days of your entitlement. Again, many times, this simply is not completed.
Source: Georgia Workers’ Compensation O.C.G.A. Section 34-9-263(c) outlines the process for PPD payments.
What are Compensable Claims?
Compensable claims are entitled to payment for the following medical expenses:
- Usual and Customary Charges
- Reasonably Necessary Items
- Covered Care or Services to Effect a Cure, Relief or Restore Employment
- Physician Visits with Status ‘Authorized’ Physicians
Source: Sections 34-9-200, 201, 203 and 205.
Whether or not medical treatment is reasonably necessary to effect a cure, give relief, or restore the employee to suitable employment, is one of the most hotly contested issues. Many times, even if the Authorized Treating Physician is the one recommending a procedure such as a surgery, the insurance company will get a second opinion. This is called an “IME” (Independent Medical Examination). Most often, longer claims create a less willing insurance company to authorize the recommended treatment.
Additional Georgia Workers’ Compensation Information
Read this page on What to Know About Workers’ Compensation Attorney Settlements
Read this post on How to Value Your Claim
Read this page on Top 10 Injured Workers Mistakes
Read this page on Top 10 Insurance Adjuster Tactics
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