Handling Workers' Compensation Claims for More Than Two Decades

Qualifying for Disability Benefits

To receive "Temporary Total Disability Benefits" or TTD benefits you must be disabled from working. Your treating physician must state you are "off-work" or totally disabled, or your physician must place restrictions on your work abilities (such as no lifting or bending) and your employer cannot or will not make you work within these restrictions.

You must be out of work at least seven days before you are entitled to receive disability
benefits. You will not receive benefits for this first week unless you are out at least 21 days. The employer/insurer has 21 days to make the first payment of TTD benefits.

Upon starting your disability payments, the employer/insurer is required to file a "Form WC-1, First Report of Injury" or a "Form WC-2, Notice of Payment or Suspension of Benefits" with the State Board of Workers' Compensation to notify them of the amount of the weekly
disability payment and the starting date, with a copy to you.

Be sure to obtain a form from the physician stating whether you are out of work or subject to work restrictions. Deliver a copy of the form to your employer and if on restriction, give the employer an opportunity to provide work within your restrictions. If there is no work within your restrictions, the employer is required to notify the insurance company and benefits will be paid to you.

If your employer does have work for you within your restrictions, but you receive less than your average weekly wage, you will be entitled to receive "Temporary Partial Disability" ("TPD") benefits for your wage loss. In this situation, ensure that your employer notifies the insurance adjuster of your gross weekly wage.

If your TTD or TPD benefits are suspended because your physician says you are capable of working without restriction, or because you have returned to restricted work at your pre-injury wage rate, within 30 days of the suspension, the employer/insurer must send a written request to your physician to issue an "impairment rating." An impairment rating is a percentage of disability from the injury to either your whole body or a portion of your body calculated according to American Medical Association guidelines. This rating is different from a work restriction and you may have an impairment rating even if you are not subject to work restrictions. Once issued, the employer/insurer has 21 days to make either a weekly payment or a lump-sum payment to you, at their option. These benefits are the permanent partial disability or PPD benefits. The number of weeks of benefits you receive depend upon the body part affected and the percentage of impairment.

Questions

Q1. Is my employer required to provide a job to me within my work restriction?

No. Under workers' comp laws, the employer/insurer is required to either provide work to you within your restrictions or to pay your weekly disability benefits. The employer/insurer has the choice of paying you benefits or providing you with a light duty job.

Aside from workers' comp laws you may have additional rights if your employer has a collective bargaining agreement with a union or if you have a written employment contract that provides additional protection. Contact your union rep or review your employment contract.

The Americans with Disabilities Act (ADA) may give you additional rights. Check with a qualified attorney or contact the United States Equal Employment Opportunity Commission (EEOC).

Q2. I was injured on my job and working light duty when my employer's factory closed. I have looked for work within my restrictions without success. Am I entitled to disability benefits until I can find another job?

If you are subject to work restrictions and you lose your job for reasons unrelated to your injury, you may be able to qualify for disability benefits. You have to make a good faith search for other employment. If you cannot obtain a job within your restrictions, the administrative law judge who hears your case may infer from your efforts that the reason you are not working is because of your injuries and award disability benefits.

Q3. If I need to perform a good faith job search to establish I am disabled, can I limit my search to jobs within my existing profession?

Generally speaking, you should look for jobs within your restrictions that you feel qualified to perform, whether those jobs are within your existing profession or not. For instance, if you worked as a construction laborer when you were injured, you are unlikely to find light work in the construction industry. In such a case, you would need to look for jobs outside the construction industry that are light enough for you to perform.

Q4. I was working within my restrictions when my employer terminated my employment because I could not perform my regular job. Do I have to look for a job before I receive disability benefits?

It is always a good idea to try to find other work if you are terminated or laid off. But if your job injury or restrictions played any part in your termination, you will be entitled to workers' compensation benefits without having to make a good faith search for other employment.

Q5. Is my employer permitted to fire me because I filed a workers' comp claim?

Yes. Under Georgia law you are an "at-will" employee unless your employer has a collective bargaining agreement with a union or you have a written employment contract. An employer may fire you for any reason or no reason, but your employer may not terminate your
employment for a reason that violates federal laws such as discrimination because of your race, sex, age, disability or religion. There is no Georgia law that prevents an employer from terminating your employment because you filed a workers' comp claim. If you are subject to work restrictions when you are fired, you may be entitled to disability benefits under workers' comp. If your job is covered by a collective bargaining agreement, you may be able to file a grievance. Contact your union steward or officer for more information.

Q6. If I am receiving workers' compensation benefits when my employer fires me, will my benefits be affected?

No. If your employer terminates your job while you are receiving either weekly benefits or medical care for your work injury, this should not affect your entitlement to benefits.

Q7. What if I am out of work receiving workers' compensation benefits and I choose to retire so that I can receive my retirement pension? Will my right to continued benefits under workers' compensation be affected by retirement benefits?

If you are totally disabled, or if your employer is not offering you light duty within your restrictions, your decision to retire should not affect your workers' compensation benefits.

Q8. I was injured on my job just before being fired for reasons unrelated to the injury. I did not think the injury was that serious, but now it is getting worse. Am I permitted to pursue a claim for benefits?

If you were injured on your job and the injury was reported either before or after you were fired, but within the required time period, you can still pursue your claim for medical care and benefits. However, claims asserted for the first time after losing one's job are
usually looked upon as suspect by employer/insurers.

Q9. If the Social Security Administration determines I am disabled, will I be able to qualify for disability benefits under workers' compensation?

A finding of disability by the Social Security Administration is a strong indication you are disabled. However, Social Security is a separate federal system. Each system has its own rules and regulations. Therefore, the Social Security Administration's (or the Veterans Administration's) finding of disability will not automatically qualify you for disability benefits under workers' compensation. If you are disabled under workers' compensation, however, qualifying for Social Security Disability is relevant to whether your work injury is
"catastrophic." (See Money Benefits)

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