Obtaining Workers’ Comp Insurance in Georgia Fraught with Difficulties

by | Published on Jun 12, 2017 | Workers Compensation

In Georgia, any business with 3 or more workers including part-time workers is required to carry workers’ compensation insurance. This insurance can provide income benefits, medical benefits, and rehabilitation benefits to employees injured in work-related accidents. Besides, it can also provide death benefits to the dependents of an employee if death occurs due to a work-related accident. This insurance is a “no-fault” system which means that an employee can receive workers’ comp benefits in Georgia even when his/her employer is not directly responsible for the injury. It also means that the employee cannot sue the employer in exchange for benefits, even if the injury is caused by the employer’s fault. Medical record retrieval and medical records review are important aspects of the workers’ comp claims processing because the medical facts are very important when deciding whether benefits are due to the claimant. In Georgia, if a worker is away from work for more than seven days because of his/her injury, he/she is eligible to receive either two-thirds of their weekly earnings or a maximum of $500 as a weekly income benefit. On the basis of the exact nature of the injury, they may qualify to accept this benefit up to 400 weeks.

Unfortunately, sometimes obtaining benefits can be really challenging for workers. Such situations arise when the employer disputes the claim arguing that the injury did not occur at work, or that the injury is not a covered type of injury. This predicament was recently revealed by a local Georgia news source, which highlighted how many Georgians injured on the job find it very difficult to access the medical care they deserve.

A study by the WCRI (Workers’ Compensation Research Institute) found that 18% or one in five Georgians injured at work and who experienced more than 7 days lost time reported “big problems” obtaining services they or their primary provider wanted. More than half of those in this group said that the reason for care denial was that employer/insurer did not want the care to be provided. The study also found that Georgians hurt on the job had some of the lowest return to work rates.

The State Workers Compensation Board chairman is concerned about these delays in treatment. What is of real concern is that there are delays in getting the authorization where there is no evident reason for the delay. Georgia law does not require prior approval for specific supplies or treatments. Even so, many doctors in the system demand some sort of payment straightaway. According to the chairman, only 13% of all Georgia workers’ comp claims opened each year end up before the Board. He said that new board rules that would come into effect next year will get judges involved sooner to sort out delays in a few days, along with the power to impose sanctions against insurance companies/employers that delay access to care without a plausible reason.

The complex nature of Georgia’s workers’ compensation laws necessitates the assistance of efficient attorneys. This will help simplify the process and increase the chances of the application being heard without unnecessary delay.

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