This is an excerpt from one of the recent episodes of 'Do I Need a Lawyer?' hosted by: Gary Martin Hays.
Now let's go to the next question from one of our viewers.
Gary - I hurt my back on the job about month ago. The employer and the insurance company finally authorized me to have an MRI. The doctor is telling me I have a herniated disk in my lower back. He wants to try epidural shots. And he told me and my wife that if the shots don't work, then I will probably need surgery.
I'll be honest - I am worried sick about this. I don't know if they are paying me the right amount in workers' compensation checks as I'm only receiving $425.00. I also don't know how long they have to pay me these checks?
Do I need a lawyer? Can you help me?
- Charlie in Loganville
Charlie, thanks for the question.
This question is easy - Yes, you need a lawyer and I'll be more than happy to help you.
But I want to address your question a little bit more to help clear this up for our viewers.
Jason Mosteller is joining me to help answer Charlie's question in greater detail.
Jason is an attorney that works with me in my law firm's workers' compensation department.
Jason - Thanks for being with us today!
Jason: Gary, Thanks for having me.
Gary: And Jason - you and I have something in common, don't we?
Jason: That's right, Gary. We both previously represented insurance companies on the other side of these workers' compensation claims. So we know how they handle these cases and turn that knowledge against them to better represent our clients.
Gary: You heard Charlie's questions.
Let's address the first one. He is receiving $425.00 in weekly workers' compensation checks.
How do we know they are paying him the right amount?
Jason: Gary, we don't know. Let me explain what I mean by that.
Under Georgia's Workers' Compensation system, the employer and insurer are required to pay Charlie 2/3 of his average weekly wage while he is out and disabled.
They calculate the average weekly wage by adding up the gross pay checks for the 13 weeks immediately before the worker's accident.
And then they divide by 13.
This is the average weekly wage.
For example: if the average weekly wage totals $600.00, the injured worker is paid 2/3 of that amount in workers' compensation wage benefits, or $400.00.
Gary: So to calculate Charlie's wage benefits, we need to review what he was being paid in the 13 weeks before his on the job injury, correct?
Jason: That's right, Gary. When we are hired by a client to represent them in a workers' compensation claim, we immediately request a complete copy of the insurance company's file on the injured worker.
We essentially send them a subpoena asking for the following documents:
-all medical records
-the panel of physicians
-and all board forms.
And in particular, I want to look at the WC-6 form.
Gary: Why is the WC-6 form important?
Jason: This is the form the employer/insurer have to complete to show how they calculated the injured workers' wage benefits.
This form will show you the wage amount they entered for the 13 weeks before the on the job accident.
Gary: What do you do if you discover the insurance company did not correctly calculate the wage benefits?
Jason: Then we immediately contact the adjuster to get the checks corrected. Plus, we ask for them to pay all of the back benefits that are due, plus add a 15% penalty.
We find that there are mistakes made a lot of times.
Gary: And this is money that belongs to the injured worker. But if they don't know how to correctly calculate that amount, or if they don't know what documents to review to see if they are being paid the right amount, the insurance company is not going to come knocking on their door to pay them the correct amount, are they.
Jason: I guarantee you they will not!
Let me quickly hit something else Charlie mentioned in his question.
He told us he has been diagnosed with a herniated disk in his lower back.
Gary, you and I both know that is an injury that he is going to have to deal with the rest of his life.
Charlie needs an attorney that is experienced in workers' compensation to step in and make sure he is taken care of medically.
Gary: That is an extremely important point.
We never want to hear a doctor tell a client of ours that he or she needs a medical test or procedure, but they are not sure the insurance company will pay for it because it is expensive.
The insurance company is obligated to pay for medical treatment that is necessary to effect a cure or provide relief. Period. And we work to get that covered for our clients.
Jason, thanks for your input.
Jason: Glad to help. And have Charlie give me a call. I know we can help him.