The following is an excerpt from Gary Martin Hays' best-selling book The Authority On Workers' Compensation Claims in Georgia. If you have questions about your rights after a work injury, give us a call at (770) 934-8000.
The two questions clients often ask us when we first meet are:
- How long is this going to take?
- What is my case worth?
There is a great deal of nuance involved in the legal aspects of a workers' compensation claim. Here is what we tell our clients:
How Long Is the Legal Process Going to Take?
The most valuable aspect of an injured worker's claim for compensation is the ability to get their medical treatment paid for by the insurance company. In most situations, it is not in the best interest of the employee to attempt to settle their worker's compensation claim until they have reached maximum medical improvement.
If any additional testing or procedures are being recommended by the authorized treating physician, you are taking a great risk by settling your claim early.
Assume you injured your lower back at work. The initial doctor that evaluates you at the occupational clinic believes you just have a muscle strain in your back. They refer you to an orthopedic surgeon for an evaluation.
The orthopedic surgeon orders an MRI. The scan reveals you have something more serious than a sprain. It shows you have a herniated disk at L3-4.
The surgeon wants you to try physical therapy and epidurals to see if this will provide some relief to you. However, you are getting tired of the entire situation. You are only getting a low weekly compensation check, you are still hurting, and you are tired of staying at home.
You may be thinking: Wouldn't it be best to settle at this point?
We would not recommend settlement at this juncture as there are far too many unknowns.
What happens if something goes wrong medically - will you be protected? If you have settled your claim, and you eventually decide on having surgery, how will you pay for it? Also, who will pay for your lost time from work while you are out recuperating from the surgery? And what happens if the surgery is not a success and you suffer further disability and the potential for more surgeries?
It is so important to have a full and complete understanding of your medical situation before you ever consider the possibility of settlement. Which brings us to our next consideration.
What Is My Workers' Compensation Case Worth?
If you don't know what the future holds for you medically, nor how much treatment will cost, you will never be able to truly put a settlement value on your claim.
There are too many unknowns when it comes to future medical bills, the length of your disability, and assigned disability rating to know what the true value of your claim will be in the beginning.
Whenever you consider settling your workers' compensation claim, it should be done after a full and complete review of your medical situation and the insurance company's potential exposure.
Important note: Settlement in any workers' compensation claim in Georgia is always voluntary by either party. We cannot do anything as an attorney to force the employer/insurer to settle your claim. Also, the employer/insurer cannot force you to settle if you do not want to do so.
It's also important to understand that Georgia's workers' compensation laws are not slanted in favor of the injured worker. The law severely limits not only the types of benefits you can recover but also the amount of those benefits. If you are injured at work here in Georgia, your benefits are limited to the following:
- wages (temporary total disability (TTD) and/or temporary partial disability (TPD);
- medical benefits; and
- a permanent impairment rating (PPD).
Unfortunately, the law does not provide compensation in a fourth category so you can recover money for pain and suffering and emotional suffering. In addition, there is no right to get in front of a jury to ask them to award you a verdict of money damages as the law limits your recovery to only the first three categories of benefits.
So, how does the insurance company put a settlement value on your worker's compensation claim?
The insurance adjuster will evaluate your claim based upon the company's exposure if they have to pay any or all of the three aforementioned benefit categories. The settlement offer will be based on:
- What are they paying you in wage benefits?
- Are you receiving Total Disability Benefits (TTD)? If so, in what amount?
- How long do they anticipate having to pay you these benefits?
- Are you receiving Temporary Partial Disability Benefits (TPD)? If so, in what amount?
- And how long do they believe they will have to pay these benefits?
You are receiving weekly TTD checks in the amount of $525 per week. Assume the insurance adjuster believes you will be out of work for a total of 2 years. This equals a total exposure of $54,600 ($525 x 104 weeks).
2. Medical Treatment
The adjuster will review your medical records and possibly call or write your doctor for more information on your medical situation.
Assume the doctor believes you will need 7 more physical therapy visits at $100 per visit. Further, you may need prescriptions that total $100 for the next 7 weeks. The doctor does not anticipate any further medical needs after physical therapy is completed. The insurance company's total exposure for medical benefits would be:
$100 x 7 therapy visits = $700 + $100 for prescriptions = $800 total
3. Disability Evaluation
When you have reached maximum medical improvement (MMI) (i.e. recovered as well as you possibly can for your injuries), the doctor will perform a disability evaluation using the American Medical Association Guidelines.
Assume your doctor tells you that you have a 7% impairment rating (PPD) to the body as a whole. The rate is calculated as follows:
7% x 300 weeks x $525 (TTD) = $11,025 in additional exposure
The total exposure can then be calculated as follows:
Total Exposure $66,425
Please understand: Even though the insurance company's potential exposure is $66,425, does not necessarily mean they are willing to actually offer you a settlement in that amount. Their goal is to pay you as little as possible to resolve your case. This is further evidence as to why you need an attorney that is experienced to help you evaluate your claim, and maximum your physical and financial recovery.
Settling Workers' Compensation Claims in Georgia
The Official Code of Georgia sets forth specific guidelines as to how workers' compensation claims are settled in the state.
When the parties have reached an agreement, a document is drafted that memorializes the settlement, and it is signed by all the parties. The settlement document is entitled Stipulation and Agreement. This document may be either a "liability" or "no-liability" stipulation as it depends on whether or not the insurance company ever paid any income benefits to the employee during the claim.
When the settlement agreement is presented to the board, the parties are essentially asking the State Board of Workers' Compensation to issue an Award approving the agreement. No workers' compensation settlement in Georgia is ever truly final until the State Board approves the stipulation and agreement.
Once the Board reviews the agreement and approves it, the insurance company has 20 days from the day of approval to issue payment to our office. If it is not paid within that time period, then a 20% penalty is added to the total settlement amount.
When the settlement agreement is approved by the State Board of Workers' Compensation, the claim is over and the claim is resolved in its entirety. The parties are legally barred by O.C.G.A. §34-9-15 from ever amending, modifying or changing the terms of the agreement in any manner.
This is further evidence of the importance of making sure you have a complete understanding of where you are medically before you consider settling your claim.
Hiring the Best Workers' Compensation Lawyers
Before Attorney Gary Martin Hays had the privilege of representing injured workers, he was a defense attorney that represented employers and insurance companies on the other side of these claims.
In that capacity, he would evaluate claims for settlement and make recommendations to the insurance company how much money they should ultimately pay to try and settle a workers' compensation claim.
When you hire the Law Offices of Gary Martin Hays & Associates, you can have the confidence and trust in that we are evaluating your claim exactly the same way that the workers' compensation insurance company and their defense lawyers are evaluating your claim.
Having worked on thousands of workers' compensation cases, our team of lawyers can anticipate the arguments and counter-arguments employers and insurance adjusters will try to use to reduce your settlement.
The whole process can be overwhelming. The good news is you are not alone. Meet with our Georgia attorneys face-to-face to go over your injuries and case details. Contact us online and schedule an appointment today.
We will review all of your rights and ensure your employer or the insurance company is not taking advantage of you or ignoring your requests.
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