February 24, 2020

Are medical and vocational rehabilitation costs covered under worker’s comp?

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.

Independent Contractors and Workers’ Compensation

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.

Judge Orders Injured Worker to Allow Insurance Company to Examine His Computer

Last July, I wrote a post on this blog about how your Facebook profile could be used against you in your case.  The Georgia State Board of Workers’ Compensation will allow defense counsel to introduce status updates and pictures to challenge your assertions that you are injured and cannot work.  This is in addition to the surveillance and other investigation that defense counsel use to impugn your credibility.

More recently I have learned of a case where the insurance company’s defense lawyer used a “request for the production of documents” to demand that an injured claimant turn over his personal computer to be examined by the lawyer.  As you may know, when you file a workers’ compensation claim in Georgia, both sides are allowed to demand information from the other per Georgia’ “discovery rules.”

Apparently, in this case, the insurance company believes that the claimant’s hard drive will reveal damaging information – perhaps photos, evidence of work or physical activity, or it may be just a fishing expedition.

Now, this was not my case, and at this point, at least, this demand for the claimant’s computer has not become a regular part of defense counsel’s arsenal, but I think that this type of request sets a very bad precedent.  I learned about this case in a monthly meeting I attend with a few other claimant’s lawyers who get together to discuss current developments in the law and winning strategies.  All of us in last month’s meeting were somewhat taken aback by this discovery request as well as the presiding judge’s approval of the request.  We all agreed that if any of use are involved in a case and the insurance company asks to look at our clients’ computers, we will fight this request vigorously. [Read more…]

Employee Gets Bad Information About Legitimate Job Injury

Although Georgia’s workers’ compensation system is supposed to foster an environment where legitimately injured workers can get needed treatment and then return to work, the reality is much different.   It has been my experience that workers’ compensation practice is just about as adversarial as divorce practice.  Often justice and fair play take a back seat to “winning” and efforts by employers insurance companies to avoid paying benefits.

Case in point.  This week I received the following email from a young woman who works at a factory in north Georgia:

Where I work I have been told that carpel tunnel is not recognized as a workman’s comp injury if I wasn’t having problems with numbness before.  Is this correct?

The short answer is “no, this is not correct.”  Repetitive motion injury (often resulting in a diagnosis of carpel tunnel syndrome) is a very common work injury, especially for factory workers performing manual labor with their hands.

Any employer who tells an employee that “carpel tunnel is not recognized as a workers’ comp. injury” is either very misinformed or downright dishonest. [Read more…]

Injured Atlanta Cops Fight Workers Comp System

A front page story in the Sunday, May 24, 2009 edition of the Atlanta Journal-Constitution details the struggle of five catastrophically injured Atlanta police officers to obtain needed medical help from the City of Atlanta’s workers’ compensation office.  Each of these police officers was injured in the line of duty – with injuries ranging from brain damage to paralysis arising from gunshot wounds to the spinal cord.

Like many city and county governments, the City of Atlanta “self-insures” against workers’ compensation claims, meaning that weekly wage benefits and funds for medical treatment come directly out of the City’s budget.  The City does use a private claim’s administration service called NovaPro Risk Solutions out of San Diego.

The City is not denying responsibility for paying wage or medical claims, but it has been refusing to pay for various medical procedures and medical devices.

In one instance a police officer who had been rendered a parapalegic from a gunshot wound needed surgery on his Achilles tendon  because his feet kept slipping off his wheelchair footrests. [Read more…]

How, When and To Whom Do I Give Notice of my On-the-Job Injury?

Several times a year, I get a call from an injured worker who is facing a denial from the insurance company on the grounds that no timely notice of a claim was filed.  The Georgia workers’ compensation statute contains two separate notice provisions, both of which must be met:

Notice to Employer

The Georgia Code says that an injured worker must give notice to his employer within thirty (30) days after his on-the-job injury.   We advise our clients to give notice, preferably in writing, to a direct supervisor.  The the sooner you give this notice the better.   When giving notice to your supervisor you should be as clear as possible about the exact date and time you were injured and about exactly what happened.    The more specific the better as we find that employers tend to question vague and uncertain reports about a work injury.

Remember that workers’ compensation covers injuries “arising out of and in the course of ” your employment.  This means that an injury incurred while you are on break, or coming or going from work may be challenged.  Be suspicious if your employer’s workers’ comp rep tries to put words in your mouth about when or how your injury happened.  A quick word about the phrase “arising out of and in the course of employment.”  The Georgia State Board of Workers’ Compensation spends a lot of its time listening to lawyers argue about what this phrase means.  What you tell your employer about your injury, and what you tell your doctor can make a huge difference.  For this reason, we encourage injured workers to seek legal counsel sooner rather than later.

Once you report an on-the-job injury, your employer is supposed to write up a “first report of injury” and send it to both the State Board of Workers’ Compensation and to its insurance carrier.   Not surprisingly, this does not always occur as employers try to avoid filing claims with their workers’ comp. carriers.   Your employer may delay filing the required paperwork and may tell you to file with your group health insurer.  They may suggest you file under short or long term disability for lost time from work.   Do not let this happen as group health and/or STD/LTD carriers will not pay for either lost wages or medical costs related to a work related injuries, as workers’ compensation insurance is considered “primary” coverage.  We have seen some situations in which the group health carrier initially accepts the claim, but later rejects it once the file is audited.  This could leave you stuck with a medical bill that otherwise should be covered.

Notice to State Board of Workers Compensation

In theory, once you give your employer notice of your injury, the employer will file a notice of claim with the State Board of Workers’ Compensation.  A better course of action would be for you to file that notice directly.  You file notice using a form called a WC-14, and this form must be filed within one (1) year from the date of your accident.  Our office regularly completes and files WC-14 forms for our client.  If you are not sure how to fill out this form, you should speak to an experienced attorney as filling out this form improperly can negatively impact your case later on. [Read more…]

Georgia State Board of Workers’ Compensation Web Site – a Useful Resource

Our firm’s blog and web site makes frequent reference to the Georgia State Board of Workers’ Compensation.   The State Board functions as the court system for workers’ compensation claims in Georgia.  The Board is a creation of the state legislature and it uses different forms that what you might see in a Georgia State or Superior Court.

I hope that this blog, along with the Ginsberg Law workers’ compensation web site, will be helpful resources for you as you educate yourself about Georgia workers’ comp. law.  Another very useful site is the web site published by the State Board itself.   While some of the material on the State Board’s site is geared towards lawyers, insurance companies and employers, there is a great deal of useful information there for injured workers.  For example the State Board web site has a very helpful FAQ section written for the benefit of injured workers.   Another section is written for employers – as injured worker, however, you can learn from this as well.  Another area of the State Board web site that you may want to review is the section that includes the various official forms that employers, insurers and claimant’s lawyers must use.

One of the main themes of the State Board site relates to how workers’ compensation is different than personal injury law.   If you understand, for example, that pain and suffering are not part of a workers’ compensation claim, or that an insurance company does not have to settle, you can make better choices in your own case.  If you are an injured worker, you obviously have concerns that transcend the organizational structure of the State Board of Workers’ Compensation.  However, you may find that an understanding of how the Board works can help you maximize your recovery should you have an injury claim.