- March 23, 2023
- Workers' Compensation
Sometimes, by the time we’ve met with a new client, their workers’ compensation claim has already been denied. Or they come to us because their workers’ comp benefits aren’t as much as they’re supposed to be. The good news is that our Atlanta workers’ comp attorneys can help figure it out and ensure that your claim is handled properly.
Your Atlanta Workers’ Comp Attorney Has to Prove You Qualify for Benefits First
Before you receive any benefits, your Atlanta workers’ comp attorney must demonstrate that you qualify for benefits. There are times when, between your employer and the insurance company, they decide not to pay your claim.
To qualify for workers’ comp benefits, you must meet the following requirements.
- Your injury occurred on company time and on company property.
- You were acting within the scope of your employment at the time of your accident.
- you reported your injury to your manager or Human Resources immediately.
- you weren’t under the influence of drugs or alcohol at the time of your injury.
- you were treated by a state-approved workers’ comp physician.
- you participate fully in your treatment.
- you don’t work a second job while collecting benefits.
As long as you meet these basic criteria, your claim should be approved. If for some reason, it’s denied, your Atlanta injury lawyer will help you file an appeal with the Georgia State Board of Workers’ Compensation.
Did Your Injuries Occur When You Were On the Clock?
Georgia law does require that you be on the clock when your accident occurs. If you’re a salaried employee, you don’t have an actual clock-in and clock-out time. Your Atlanta workers’ comp attorney would instead have to demonstrate that you were working at the time of your injury.
In addition to being on the clock, you must have also been acting within the scope of your employment when you got hurt. For example, if you work as a cashier in a hardware store, unloading trucks is not part of your job description. If this is how you got hurt, your claim may be denied.
Your Atlanta Injury Lawyer Will Make Sure You Receive Your Workers’ Comp Benefits
Once you submit your claim, the insurance company has 21 days to file its response. When they do, you’ll receive a copy of their decision. Typically, the response will be one of the following three things.
- Your claim will be approved for both medical care and weekly wages.
- Your claim was approved for medical care only.
- Your claim was denied entirely.
Once you get your form in the mail, make sure you show your Atlanta workers’ comp attorney a copy of it. If your claim was denied in part or in whole, your Atlanta injury lawyer will help file an appeal. Whether the appeal is successful will depend on the reason for their denial.
You Should Be Entitled to Medical Care
In almost all circumstances, injured workers will be provided with the medical care they need. If you were hurt at work, the least your employer can do is make sure your medical bills are taken care of.
In addition to medical coverage, you should also be approved for weekly replacement wages. These wages will start once you’ve missed at least seven days from work. They will continue for up to 400 weeks or until you reach maximum medical improvement – whichever comes first.
How Are Your Weekly Workers’ Compensation Benefits Calculated in Atlanta?
When your employer submits your claim to the insurance company, they must provide them with your wage information. It is up to your employer to ensure that the correct information is sent.
Once the insurance company has this information, it is rather simple for them to calculate your weekly workers’ comp benefits.
You’ll Be Entitled to Two-Thirds of Your Average Weekly Wages
Your weekly benefits will be equal to two-thirds of your average weekly wages. For example, if you typically earn $1,000 per week (gross), you’ll receive $666 per week while on workers’ compensation.
It’s important to remember that the most you can receive per week in Georgia is $675. This means that, if you make more than $1,022 per week on average, you will lose money while on workers’ comp.
Let Your Atlanta Workers’ Comp Attorney Know if Your Benefits Amount is Incorrect
If your claim is approved, you should receive your first benefit check in a matter of weeks. When you get your first check or direct deposit, make sure it’s for the right amount. If you aren’t sure what the amount should be, do the following calculation.
- Divide your Annual Gross Income by 52 (the number of weeks in a year).
- Multiply this amount by .66 (%).
- This final amount is what you will receive per week.
If this final amount is greater than $675, the most you’ll receive is $675. If the amount still looks off, make sure you let your Atlanta injury lawyer know immediately. They’ll have to talk to your employer and things will be straightened out right away.
What Types of Income Are Considered for Purposes of Workers’ Comp Benefits?
When determining how much you should receive each week, make sure to include all types of income. This would include the following:
- Regular wages (gross income)
- Tips
- Bonuses
- Commissions
- Car payment/reimbursement
Take the total (for the year) and divide it by 52. This will give you the average weekly wages for your prior year. You then need to multiply this amount by .66, which represents the two-thirds that you’re entitled to.
Obviously, Your Regular Wages or Salary Will Be Included in Your Benefit Calculation
Clearly, your regular wages will be included for benefits purposes. It gets tricky when it comes to other types of income. For example, if you’re a server, you will need to find out what your average tips were for the prior 52 weeks (year).
The same is true for commissions and bonuses. These are the types of income your employer or insurance carrier usually forgets to include.
Meet With One of Our Skilled Atlanta Workers’ Comp Attorneys Right Away
If you’ve been hurt on the job, there’s a good chance you’re entitled to workers’ compensation benefits. We suggest you call and schedule your free, initial consultation with one of our Atlanta injury lawyers.
Your Atlanta workers’ comp attorney will make sure your claim is handled properly from the start. They’ll make sure your benefits are calculated properly. If they aren’t, we’ll reach out to the insurance carrier and make sure they correct the issue.
Since the consultation is free, you have nothing to lose. Call today and find the date and time that works best for you.
