Stephen Hasner | Workers' Compensation | January 6, 2025
Not all settlements for work injuries are the same – not even close. How much you can recover in a Georgia workers’ compensation claim depends on the severity of your injuries and the benefit types you’re pursuing. Other factors, such as your medical costs and income losses, also influence final compensation amounts.
To ensure you receive the benefits you need, it’s advisable to have a local workers’ compensation lawyer evaluate your case. Their knowledge of state laws and their relationships within Georgia’s workers’ compensation insurance and legal systems can significantly benefit your claim. This support and guidance can maximize your settlement.
Schedule a free consultation with a Georgia workers’ comp attorney to get started.
Workers’ Compensation Disability Benefits
Workers’ compensation is an important employer-based insurance program that provides coverage for work-related injuries and illnesses regardless of fault. Benefits should pay for 100 percent of healthcare costs, as well as cash benefits for a percentage of lost work time—after a three-to-seven-day waiting period.
For more serious injuries and cases, workers’ compensation benefits might include the following:
- Temporary Total Disability Benefits (TTD): Paid when work-related injuries and illnesses temporarily prevent you from returning to your job pre-injury or another job from the same employer. Benefits continue until returning to work or reaching your maximum medical improvement (MMI). Your MMI refers to when you have recovered from your injuries or reached a treatment plateau where no further treatment will improve your condition.
- Temporary Partial Disability Benefits (TPD): Some workers return to work before achieving their MMI, with restricted duties or lower or differential earnings. Injured workers returning to work at less than the pre-injury pay receive TPD benefits. Pay equals two-thirds of your average weekly income.
- Permanent Total Disability Benefits (PTD): PTD benefits are paid to workers who cannot work because of a work-related injury or illness. They are paid at a rate similar to TTD but extended for a lifetime. Injured workers suffering severe impairments judged to be permanent after reaching their MMI receive PTD benefits.
- Permanent Partial Disability Benefits (PPD): Calculated based on the severity of your impairment, PPD benefits are available for permanent impairment that does not fully disable or entirely limit your ability to work. PPD cases are rare, accounting for less than one percent of cases involving cash benefits.
- Death Benefits: If a work injury is fatal, the worker’s family or dependents may receive death benefits. These benefits generally cover funeral and burial expenses and provide cash benefits for a portion of the deceased worker’s earnings.
Most employers in Georgia with three or more employees must provide coverage by purchasing workers’ compensation insurance or funding approved self-insurance plans. Employees are generally covered under the program; however, some aren’t, such as independent contractors, sole proprietors, business partners, and federal employees (who have different coverage). Industries such as agriculture and maritime work have individual federal regulations regarding workers’ compensation, exempting them from state workers’ compensation laws.
Additionally, workers’ compensation does not cover injuries resulting from violating company policies, protocols, and procedures or when an employee is not on the job. Finally, injuries caused by horseplay, intoxication, illegal activities, and intentional acts are exclusions from workers’ compensation benefits.
During your free case evaluation, a Georgia workers’ compensation attorney can assess your employment situation and advise on the benefits you are eligible for in your workers’ compensation claim.
Factors Influencing Your Georgia Workers’ Compensation Claim
How much you can recover in a Georgia workers’ compensation claim depends on many factors, including your:
- Injury severity and type
- Medical expenses
- Permanent impairment rating
- Pre-existing conditions
- Lost income
Your average weekly income, age, earning potential, and vocational rehabilitation needs are also considerations. Finally, the timeline of your case, insurance company tactics, negotiations, and legal representation significantly impact how much you can recover in a Georgia workers’ compensation claim.
Injury Severity and Type
The type of injury you sustain directly relates to the severity of its impact and worth. The more severe the injuries, the higher settlement you can recover in a Georgia workers’ compensation claim. When injuries prevent you from returning to work at full capacity or at all, it generally results in substantial financial settlements. Minor sprains and lacerations will receive significantly lower workers’ compensation benefit amounts compared to more significant injuries, such as amputations and compound bone fractures.
Medical Expenses
Your medical expenses are critical in how much you can recover in a Georgia workers’ compensation claim. Severe injuries requiring extensive medical and surgical treatment and rehabilitation services or resulting in long-term disability incur outrageous healthcare costs. These expenses frequently include the following healthcare services:
- Ambulance and other emergency services
- Life-saving procedures and hospitalizations
- Surgical and primary care
- Rehab specialist services (physical therapy, orthopedics)
- Medical assistive devices
- Pharmaceuticals
- Dental care
If future medical treatment is necessary, your attorney will work with medical experts and economists to anticipate and include these costs in their claim valuation. They will calculate future healthcare costs for ongoing primary care, surgeries, therapy, and prescription medications.
You must keep detailed records of all your healthcare bills and treatment plans to ensure your attorney accounts for every medical expense in your workers’ compensation claim. Provide them copies of medical billing statements and receipts for copays, prescriptions, and insurance deductibles.
Permanent Impairment Rating
Treating physicians assign injuries resulting in permanent disability with a permanent impairment rating, quantifying your disability’s extent. They will medically assess the percentage of long-term functional loss sustained due to injury before assigning your permanent impairment rating. Ratings are generally assigned after you’ve hit your MMI. Your permanent disability impairment rating is used to calculate how much you may recover in permanent disability benefits.
Pre-Existing Conditions
Worker’s compensation laws factor in pre-existing medical conditions when assessing claim amounts. When pre-existing conditions are present, insurers may argue for reduced compensation, claiming part of your condition existed before the accident. Examples of what qualifies as a pre-existing condition are as follows:
- Previous injuries (torn muscles or ligaments, broken bones, back and neck injuries)
- Chronic conditions (carpal tunnel syndrome, arthritis, tendonitis)
- General health conditions (anxiety, depression, asthma)
- Old sports injuries (tennis elbow, concussion, stress fractures)
A pre-existing doesn’t necessarily mean claim denial or a disqualification from workers’ compensation benefits. You may be eligible when a work injury or exposure worsens a pre-existing condition. For example, if you have spinal arthritis and lift a heavy object at work, causing a torn ligament, your employer may be liable. Injured parties with pre-existing conditions should consult a workers’ compensation attorney immediately. You’ll want to be prepared with a legal strategy and lawyer to argue it if they attempt to deny or undervalue your claim.
Lost Income
Income losses are a significant factor in workers’ compensation claims. The amount you will receive is based on two-thirds of your average weekly income (AWW) before your injuries, up to state limits. In Georgia, that means a maximum of $800.00 per week—for an accident on or after July 1, 2023. Your AWW is based on your earnings in the 13 weeks before your injury. It accounts for wages, overtime, and non-salary compensation, such as tips, commissions, and bonuses. Depending on the severity of injuries and lost earnings, future loss of income is another consideration.
Age and Earning Potential
An injured worker’s age may significantly impact the amount they recover in a workers’ compensation claim. Older employees generally experience longer recovery due to the natural aging process and pre-existing conditions, which can lead to higher compensation costs for insurers. Other factors considered are the remaining earning capacity based on age and potential retirement timeline. Younger claimants with permanent disability may see higher settlements due to the many more years of expected lost earning capacity.
Vocational Rehabilitation Needs
You may need vocational rehabilitation if injuries prevent returning to your pre-injury job. These needs may dramatically influence the value of your Georgia workers’ compensation claim by increasing the potential payout. Vocational rehabilitation needs are additional services, such as career counseling for finding new employment or job training—the more significant the need for vocational rehabilitation, the higher the settlement amount. Documenting your inability to perform your previous job involves a vocational evaluation and detailed medical records.
Case Timeline
The timeline in your case impacts your workers’ compensation settlement amount. Settling too soon can mean future medical costs and lost earnings being unaccounted for at your expense. Delays in reporting injuries, filing a claim, or reaching your MMI may lead to challenges, such as claim denials or reduced compensation amounts.
The sooner you seek medical care and contact an attorney to initiate the claims process, the better your odds of securing a higher settlement. The statute of limitations for Georgia workers’ compensation claims is one year from the accident date. Employees must inform their employers within 30 days of the injury.
Insurance Company Tactics
Insurance companies are notorious for using tactics to influence workers’ compensation claim amounts. It is an insurance claim adjuster’s job to maximize company profits. To minimize losses, insurers may employ these common tactics for delaying and denying claims:
- Disputing the necessity of medical treatments and procedures
- Delaying claim processing so an injured worker may give up accepting a lowball offer
- Sending lowball settlement offers to encourage early settlements
- Limiting the choice of medical providers to their network who are more likely to downplay the severity of injuries
- Requesting recorded statements to get injured workers to say something they can use to deny liability
- Denying claims based on technicalities or contesting whether an injury is work-related
- Pressuring injured workers to return to work before being fully recovered or achieving their MMI
The best way to protect yourself from standard insurance company tactics is to hire a worker’s compensation attorney to represent you. After retaining legal counsel, insurers are not permitted to contact you further about your workers’ comp claim. Your lawyer will handle all communications moving forward. If insurance companies continue to call or harass you, you must inform your attorney. They can file a bad-faith insurance claim and report the behavior to the appropriate authorities.
Negotiations
Negotiating is vital to how much you recover in a Georgia workers’ compensation claim. The process typically involves back-and-forth communication between your lawyer and the insurance company, including offers, potential counteroffers, and compromises, until a final agreement is possible. Your lawyer will inform you of settlement offers and have the power to accept or deny them. Your attorney will provide legal insight on what they think is best.
Legal Representation
Claimants who have legal representation tend to receive full settlements. Experienced lawyers understand workers’ compensation laws and cases every day. They will ensure all damages, including future medical and disability costs, are calculated. Workers’ comp attorneys are skilled negotiators who understand how much a claim is worth and will fight to ensure a reasonable settlement. An attorney will also represent you in claim hearings or disputes.
Lump-Sum vs. Structured Workers’ Compensation Settlement
Once an agreement is reached, payments will be structured settlements or lump sums. A structured settlement is a pre-determined payment allocated for a period of time or, in some cases, life. This option allows injured parties to receive ongoing financial support and avoid spending outrageous sums of money. Structured settlements may benefit claimants with long-term medical and rehabilitation needs. Lump-sum payments issue the entire settlement amount at once, providing immediate access to the funds.
How a Workers’ Compensation Lawyer Can Help
You don’t have to interpret Georgia’s workers’ compensation laws and insurance claim processes alone. An experienced attorney can add significant value to handling your claim while allowing you to prioritize recovery. They will inform you of your legal rights under workers’ comp laws and explain potential outcomes and limitations. Other benefits of hiring a workers’ compensation lawyer include:
- Proper form completion with accurate documentation
- Meeting filing deadlines
- Gathering evidence, such as medical bills, witness statements, and expert witness testimony
- Provide medical treatment guidance, ensuring you work with appropriate providers for your treatment
- Settlements of negotiations
- Dispute resolutions in hearings and appeals
Speak to a personal injury lawyer before filing your claim. You’ll want to properly understand the claims procedure and what to expect. An attorney can provide valuable insight into how to maximize your workers’ comp claim. Schedule a free case evaluation.
