Who Pays for Workers’ Compensation Benefits?

Dec 30, 2020

Workers’ compensation coverage is paid for by employers, not employees, making it a somewhat unique benefit compared to other types of insurance coverage.

Employees who get health care coverage through their jobs usually have their payments removed from their paycheck each pay period, like withholding for Social Security and Medicare. That’s not really how workers’ comp coverage works. It is one of the few “benefits” that an employer must pay for out of their own pocket.
Describing workers’ comp as a benefit may be misleading because benefits are usually thought of as optional. In Georgia, for example, most businesses are required to carry workers’ compensation insurance. It’s not just an option generous employers can offer their workers.

Temporary Compensation Doesn’t Always Fix the Damage an Injury Causes

The severity of some jobsite injuries may prevent a worker from being able to return to their position or meet performance expectations until they’ve recovered.

A construction worker who suffers a repetitive stress injury may require surgery to fix a problem or they may simply not be able to do their job anymore.

In some cases, employers can work around those restrictions but in other cases a worker may be forced to find a new line of work. During that time, they may not be able to earn a living, which can jeopardize every facet of the worker’s life.

Workers’ compensation insurance is designed to account for all these different scenarios. The benefits it offers injured workers are intended to be flexible enough to help them make a full recovery – whether that just requires temporary income replacement and rehabilitative care or orthopedic surgery and job retraining.

A Note on Workers’ Compensation Laws in Georgia

Any business in Georgia with three or more employees (including part-time employees) is required to carry workers’ comp insurance. You can learn more about Georgia’s workers’ comp laws on the State Board of Workers’ Compensation website.

People who have suffered a workplace injury should file a WC-14 with the State Board of Workers’ Compensation as soon as possible. A copy of the completed WC-14 should also be sent to the injured worker’s employer and their insurance provider. WC-14s must be filed within a year of the date of the injury. 

Weekly Income Benefits

People who are out of work for more than seven days due to an injury are entitled to weekly income benefits, but your workers’ comp insurer has 21 days to send your first check. That means even if you’re unable to work for a week or more you won’t be able to receive wage benefits right away, although you are still entitled to them.

The wage benefits are set at two-thirds of your weekly average pay and are capped at $675 a week.

If for whatever reason your injury prevents you from returning to your previous job, and you must return to work at a lower-paying position, you may be entitled to reduced benefits for up to 350 weeks after your injury.

Workers’ comp income benefits can last for years – up to 400 weeks or even a lifetime – depending on the circumstances.

What Determines Income Benefits Eligibility

Proving eligibility to receive these benefits isn’t always a simple thing. Your treating physician’s assessment will likely be the most important determining factor.

Treating physicians are doctors who diagnose a worker’s condition, refer workers to specialists, dictate work restrictions or make determinations about a worker’s level of disability.

The treating doctor is the expert who provides medical records and evidence to an employer’s workers’ comp insurance provider, so any benefits injured workers receive will be based on that doctor’s assessments.

In most cases injured workers can’t just go to their normal primary care physician to receive these assessments. In Georgia, if your employer has posted a “panel of physicians” you will be required to go to one of those doctors. That panel doctor will take on the role of treating doctor to make those assessments and gather the relevant medical evidence.

Employers in Georgia are required to post this panel (in English and Spanish). If for whatever reason the first doctor you choose isn’t a good fit, you are allowed to change to another treating doctor on the panel list.

Employers do have some restrictions when choosing panel doctors:

  • Must be accessible to their workers
  • At least one orthopedic specialist
  • No more than two “industrial clinic” doctors
  • At least one minority doctor

If none of the panel doctors are accessible to an injured worker, they may have more flexibility in choosing their own treating physician.

Getting Workers’ Comp Benefits Isn’t Always Easy

The laws regulating workers’ compensation benefits are complicated, and a lot of things can stand in the way of injured workers getting the benefits they deserve.

Some employers fail to carry adequate workers’ comp coverage, or they try to choose a panel of doctors that will be predisposed to downplay the severity of injuries.

Some workers even face workplace harassment or threats to their job for seeking to claim the workers’ comp benefits to which they are entitled.

Employers and injured workers also have a right to an administrative hearing if they want to challenge claim approval or denial. Employers will usually be represented by a lawyer at these hearings, which is why it often behooves the injured worker to retain the services of a workers’ compensation attorney.

If you believe you have a legitimate workplace injury and you’re being pressured not to file or are being prevented from filing a workers’ compensation claim, the personal injury lawyers at the Dressie Law Firm are here for you. Call us at 770-756-6333 for a free consultation.

Workers+Compensation+Benefits+ +Dressie+Law 1920w


Download PDF