Suffering from a work injury while attempting to navigate a workers' comp insurance claims is stressful in and of itself. The last thing you want on top of that is to suffer financially because you didn't receive the compensation to which you were entitled. Make sure to contact an experienced workers' comp lawyer.
Insurance companies are never going to fully educate you on your entitlement to fiancial benefits.
However, the unfortunate reality is that workers' comp benefits are likely to be your primary and sole source of income while you recover from your injuries. Therefore, a basic understanding of these benefits is crucial.
Temporary Total Disability (TTD) checks are payable to an injured employee when her or she is not working. However, several parameters are set as to when they are payable, how long they are payable, and how much is actually owed.
You may be eligible for TTD checks if your Authorized Treating Physician (ATP) says you cannot work at all. Once your ATP says you can return to work at full capacity, your entitlement to TTD ends.
If your ATP says you may return to work in a light duty capacity, your entitlement to TTD ends upon your return to a light duty position if one is available.
If your ATP assigns light duty work restrictions but your employer does not have work to accommodate those restrictions, you may be entitled to TTD checks.
Under some circumstances, you may be entitled to TTD checks if you are unable to perform the light duty job offered by your employer.
For non-catastrophic cases, TTD checks are payabe for up to 400 weeks from the date of injury.
If your injury is deemed catstrophic, you may be entitled to lifetime TTD checks.
In some instances, the insurance company may reduce both the amount of your weekly checks and maximum duration of payment.
Even if you qualify for TTD checks, you will not receive your full pay. Instead, you are entitled to two-thirds of your average weekly wages.
However, the most you can receive is $800.00 per week, even if two-thirds of your average weekly wages is actually higher.
The insurance company has 21 days from the day your entitlement to TTD begins to mail you a check.
Further, unless you are out of work for 21 consecutive days, the insurance company is not required to pay you for the first week.
There is a 15% penalty if a TTD check is late. If the check is mailed from within the state of Georgia, it is late if it is not mailed within the week that it is due.
If the check is mailed from outside of the state of Georgia, it is late if it is not mailed three days before the first day of the week for which payment is being made.
If you are receiving TTD checks and the insurance company attempts to send you back to work in a light duty capacity, you are not required to perform the job unless and until the insurance company complise with what is known as the WC-240 process:
The insurance company must send a copy of the light duty job description to your ATP and get the ATPs signed approval whithin 60 days of your last appointment with the ATP.
If your ATP signs off on the light duty job, the insurance company must file and provide you with a copy of a WC-240 entitled Notice to Employee of Offer of Suitable Employment. This lays out the job description signed by the ATP and provides the details regarding your start date, time, and location.
The WC-240 must be provided to you no less than 10 days before your anticipated return to work date.
If the insurance company has complied with the WC-240 process, you must at least attempt the light duty job for at least 1 day or an 8-hour shift (whichever is greater). If you are unable to perform the job, the insurance company must recommence your TTD checks.
Depending on the circumstances, Temporary Partial Disability (TPD) checks are payable to eligible injured employees who are on light duty work status, per their ATP.
These payments are capped at $533.00 per week and are payable for a maximum of 350 weeks from the date of injury.
There are two different circumstances under which TTD may be paid:
You may be entitled to TPD checks if you are on light duty work status per your ATP and you are earning less money in your light duty work position than you were earning prior to the wreck.
In that case, you would be entitled to two-thirds of the difference between your pre-accident pay and your light duty pay. However, the maximum amount you can receive is $533.00 per week, even if the actual two-thirds difference in your pay is greater.
If you are on light duty work status per your ATP but you are not working, either because there is no light duty work available or because you are unable to perform the light duty work that is available, the law allows the insurance company to file a WC-104.
One year after the isurance company files the WC-104, your TTD checks are essentially converted into TPD checks. This means that at the end of the one year period, the value and duration of your TTD payments are reduced to those of TPD payments.
Depending on the severity of your injury, you may never recover to be 100% as healthy as you once were despite adequate medical care. If your ATP determines that to be the case, he or she will assign a permanent partial disability (PPD) rating rating for each injured body part.
For example, let's say you injured your back and y our knee. Your back is 90% as healthy as it was prior to your accident, and your knee is 95% as healthy as it was prior to your accident. Your physician would assign a 10% PPD rating to your back and a 5% rating to your knee.
The insurance company will then use those ratings to calculate how much to pay you for your permanent impairment. This amount will either be paid in a lump sum or in weekly installments, but it will not be paid until you are no longer receiving weekly checks in the form of TTD or TPD.
Multiply your average weekly wages by the number of weeks that the law assigns to your particular injured body part. Then multiply that number by the impairment rating assinged by the ATP.
Example:
Average weekly wages are $400.00, injured back (300 weeks), and a 10% impairment rating.
400 x 300 x .10 = 12,000
Your PPD is worth $12,000.00
If a injured worker dies as a result of his or her injuries, workers' comp insurance may pay up to $7,500.00 in burial and funeral expenses.
Additionally, if the decesased had a spouse and/or dependents, they may be entitled to weekly compensation.
Whether or not they qualify for weekly compensation and for how much they may qualify can be tricky and requires a detailed analysis. Therefore, you should always consult an experienced workers' compensation attorney.
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The Barionnette & Eisenhower Law Firm, LLC
2310 Parklake Drive, Suite 460 - Atlanta, GA 30345
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