Workers’ Compensation Insurance can cover mental conditions. However, for this to happen, you really need to be able to link the mental condition to a specific event – such as a traumatic event experienced on the job or the development of a physical problem which then lead to your mental problem. Mental health issues are rarely compensable in and of themselves; linking them to physical events is key to receiving workers’ comp benefits based on psychiatric issues.
The argument would go something like this: At such and such time, you were injured on the job, at which point in time you begin exhibiting the signs of depression. The depression is clearly related to your job injury, and thus you should be eligible for Workers’ Compensation. Another example would be an individual having a heart attack due to the stress of their job, and in the aftermath developing an anxiety disorder which has debilitating consequences.
In any event, to get workers’ comp benefits, the primary condition or injury should really be physical in nature; however, mental conditions of the person would definitely be taken into consideration. Just know that for the most part, it must be proven that the mental condition was a direct result of a work environment that was not normal or a specific triggering event/injury.
Which leads to a last point – you will need evidence to show that this is the case. Naturally, something like a psychiatric evaluation would be required in order to determine whether a mental condition exists and whether it resulted directly from performing one’s job responsibilities.
Mental Health Issues and Workers’ Comp Case Study: The case of “Ms. D”
Ms. D experienced a head injury while on the job and was treated for it. However, she has been plagued with recurring headaches since the injury and treatment occurred. According to Dr. X, Ms. D suffers from continual headaches, and medical reports show that the headaches appear to be a direct result of the original injury and the medications taken as part of treatment.
In addition to the above, though, Ms. D is also anxious, depressed, and having difficulties sleeping. Consequently, she was fired from her 25-year job and hasn’t worked since. To deal with her mental health issues, she needs psychiatric care for depression, and relaxation techniques as prescribed by Doctors X and Y. She has been placed on “no work” status, and the net result of all of this will require that she receive TTD payments.
As her lawyer, I looked at all this information and was able to argue for a clear connection between the initial traumatic injury and the ongoing headaches and psychiatric issues. Treatment for both of these ongoing issues was pricey (we reviewed the costs and quotes for ongoing care), and we calculated a settlement amount for our client based on future medical care, follow-up appointments, future medications, and TTD requirements. Based on all the above, we demanded settlement of “X” amount on behalf of Ms. D’s and were able to successfully settle.
In conclusion, this was a case where we were able to get compensation based partially on mental health issues, but the key was clearly tying those issues to a physical event – in this case an on the job head injury.
Filed under Case studies, Depression by 
What is an independent contractor?
Any business, corporation, or individual that provides products or services to a business entity and is specified contractually or by verbal agreement is referred to as an “independent contractor.” According to the IRS tax codes, they are not defined or recognized as an employee of that business or corporation. They typically work as they are required to and are usually subject to what is called the Law of Agency.
Additionally, independent contractors (hereinafter referred to as IC’s) are responsible for paying their own federal and state taxes; this is not the responsibility of the business, corporation, or individual who has contractually procured the IC’s products or services. Compensation is normally made on a freelance basis and the IC may be working through a limited company which they own themselves or via what is called an “umbrella company,” a company that acts as the agent for the IC.
Does worker’s comp cover the independent contractor?
Under the worker’s compensation laws of the state of Georgia, independent contractors are not covered for any injury sustained while performing their work. However, the definition of an independent contractor under state statutes has very specific guidelines in order to determine if the individual is an employee or an IC. Employers do not always use this definition correctly or properly. Additionally, the IRS’ guidelines regarding IC’s are not followed by worker’s compensation law.
For these reasons, this is a very problematic area. However, it is extremely ironic that an individual who has opted for being an independent contractor and who engage in dangerous or high risk occupations are not covered by Worker’s Compensation Insurance based on their independence or freedom from an employer. But the fact that employers would love to classify employees as independent contractor is what leads some to cheat and do exactly that so they are not responsible for worker’s comp benefits.
The bottom line is that if a business owner or corporate entity has 3 or more individuals working for them and they require a method, manner, time, and the type of work that the individuals are expected perform, they cannot classify the individual as an IC. Any business owner who employs 3 or more individuals is required to carry Worker’s Compensation Insurance. It is not surprising then that some employers try to “cheat the system” in order to avoid purchasing this type of coverage.
If you would like more information regarding the independent contractor/worker’s compensation issue, please feel free to contact us at our website. We will be happy to answer any questions you may have and provide you with additional information.
Filed under Employee vs. independent contractor, Georgia Workers' Compensation by
Who is entitled to worker’s compensation benefits?
In the state of Georgia, you are entitled to receive worker’s comp benefits if you are injured on the job and the following criteria are met:
- You are a regular employee – whether full-time or part-time
- Your employer has employed 3 or more individuals
- You are not an Independent Contractor (IC)
Additionally, you cannot be employed in certain industries or occupations such as maritime or railroad, as they provide their own types of benefits insurance. Typically, there are 3 primary forms of benefits:
- PPD or Permanent Partial Disability
- TPD or Total Partial Disability
- TTD or Temporary Total Disability
In addition to the above benefits, your employer is responsible for providing you with the medical care and treatment you need at their expense. Typically, your employer provides you with medical benefits by selecting certain providers of medical care for the injured employee. The listing of medical providers is oftentimes referred to as Managed Care Organizations or MCO’s.
What is a Managed Care Organization?
Managed care is defined as a variety of methods or techniques which are intended for the reduction of costs associated with providing health care and medical benefits. Additionally, the other intention of managed care is to improve the quality of that health and medical care for those organizations that use these methods and techniques. These organizations are referred to as MCO’s or Managed Care Organizations.
The terminology managed care is also used to describe systems for delivering and/or financing health and medical care to enrolees who are organized around certain managed care concepts and techniques. A managed care organization refers to any entity which manages the use of health and medical care as well as the associated costs specific to worker’s compensation claims.
Some of the more common MCO’s
There are several groups of organizations currently providing managed care for employees who have sustained on-the-job injuries. Each of them operate using business models that are slightly different from one another. Some of these organizations are comprised of a mixture of hospitals, physicians, and other health care providers whereas others are comprised exclusively of physicians. The most common MCO’s are:
- Group practice without walls
- Independent practice associations
- Management services organizations
- Physician practice management companies
Additionally, there are several other network-based MCO’s such as HMO’s (Health Maintenance Organizations, IPA’s (Independent Practice Associations), and PPO’s (Preferred Provider Organizations).
Filed under Medical Care by
What is Worker’s Compensation?
Worker’s compensation, or more colloquially worker’s comp, refers to a type of insurance which provides certain benefits to employees that are injured on the job such as income due to lost wages and medical treatment. Additionally, the employee relinquishes their right to sue the employer for negligence once they file a worker’s compensation claim. Oftentimes, the trade-off between the assured, limited coverage versus the relinquishing of legal recourse is referred to as “the compensation bargain.”
What is covered and not covered?
While there are some differences between state worker’s compensation laws, the underlying intention and premise of worker’s comp benefits is the same. For instance, in the state of Georgia, any employer who employs three or more individuals, regardless of full-time or part-time status, must provide worker’s compensation insurance. They must also provide the injured employee, at their expense, proper medical care for the on-the-job injury.
Additionally, in cases involving the loss of a limb or the death of the employee is the case, worker’s compensation benefits are also provided. For instance, if you lose an arm or a leg and this causes you to take a lower paying job or position, you are entitled to benefits to cover the loss of wages. Similarly, if you die as a result of the industry, your spouse and children are entitled to benefits.
Other benefits that may be necessary
In addition to the above, not all of the benefits provided by Worker’s Compensation Insurance involve lost wages and medical care. Sometimes it is necessary to provide the injured employee with either rehabilitation benefits or vocational benefits. If this is the case, you will receive these benefits should there be an injury rehabilitation period involved, or if you need vocational training in order to perform a different job or have to take on a new position in the company where you were injured.
Worker’s comp rehab benefits apply to a variety of circumstances when they become necessary due to the on-the-job injury you have incurred. These include:
- Prosthesis and learning how to perform your job with the artificial limb
- Physical therapy required in order so that you can function and perform your job normally
- Speech therapy
- Vocational therapy (learning how to perform a different job)
If you need further information regarding any of the above or have any questions, please call contact us by visiting our website or sending us a comment using the form below.
Filed under Georgia Workers' Compensation by
