Feb 15, 2021
Who is Responsible for the Payment for a Workers’ Compensation Case?
Nate Hansford
If you have been injured on the job in Georgia, one of the first questions you may have is who pays for your workers’ compensation benefits. Understanding where the money comes from and how the payment process works can help you feel more confident as you navigate your claim. The short answer is that your employer’s workers’ compensation insurance company is responsible for paying your workers’ compensation benefits, not your employer directly and not you.
At Hansford McDaniel, Workers’ Compensation Attorneys, we help injured workers throughout Georgia understand every aspect of the claims process, including who is financially responsible for their care. Our attorneys have over 100 years of collective experience handling workers’ compensation claims, and we know that confusion about payment responsibility is one of the biggest sources of stress for injured workers. We are here to make sure you receive every benefit you are entitled to under Georgia law. We speak English and Spanish.
How Workers’ Compensation Insurance Works in Georgia
Workers’ compensation is an insurance program that your employer pays for entirely. No money is deducted from your paycheck to fund this coverage, and you do not need to sign up or enroll. Coverage begins automatically on your first day of employment. According to the Georgia State Board of Workers’ Compensation, any business that regularly employs three or more workers, including regular part-time employees, is required to carry workers’ compensation insurance. This applies to industries across the board, from office environments to construction sites and warehouse operations.
When you are injured at work, your employer’s insurance company is the party responsible for paying your benefits. This includes all authorized medical treatment, income benefits to replace a portion of your lost wages, and rehabilitation services. Your employer pays monthly premiums to maintain this coverage, similar to how you pay premiums for auto or health insurance. The employer does not pay your benefits out of pocket unless they are self-insured, which is uncommon and only available to large employers who have been approved through the Georgia Self-Insurers Guaranty Trust Fund.
What Benefits Does the Insurance Company Pay
The workers’ compensation insurance company is responsible for covering several categories of benefits after a workplace injury. Medical benefits include all necessary treatment related to your work injury, such as doctor visits, hospital stays, surgeries, prescription medications, physical therapy, and assistive devices. You should not have to pay any out-of-pocket costs for authorized medical care related to your workplace injury.
Income Benefits and Weekly Caps
If your injury prevents you from working, the insurance company pays income benefits to replace a portion of your lost wages. In Georgia, temporary total disability benefits equal two-thirds of your average weekly wage, up to a maximum of $800.00 per week. If you return to work at reduced capacity or in a lower-paying role, temporary partial disability benefits cover two-thirds of the wage difference, up to a maximum of $533.00 per week for up to 350 weeks. For most non-catastrophic claims, income and medical benefits are limited to 400 weeks from the date of injury. Workers who suffer catastrophic injuries such as amputations, paralysis, or severe brain injuries may qualify for lifetime benefits without this cap.
What Happens if Your Employer Does Not Have Insurance
Georgia law imposes penalties on employers who fail to carry workers’ compensation insurance. The State Board of Workers’ Compensation can assess civil penalties ranging from $500.00 to $5,000.00 per violation for an employer’s failure to maintain coverage. In addition, the Board may assess attorney’s fees and a 10 percent increase in compensation to the injured employee. If your employer does not have insurance and you are injured on the job, you still have legal options. You may be able to file a claim directly with the State Board or pursue a civil lawsuit against your employer. An experienced attorney can help you determine the best path forward.
Can You Sue Your Employer Instead of Filing a Workers’ Compensation Claim
Georgia’s workers’ compensation system operates on a no-fault basis, which means you are entitled to benefits regardless of who caused the accident. In exchange for this guaranteed coverage, the law generally prevents employees from suing their employer for additional damages related to the workplace injury. There are very limited exceptions to this rule, typically involving intentional harm or conduct that goes far beyond ordinary negligence. If a third party, such as a manufacturer of defective equipment, contributed to your injury, you may be able to pursue a separate personal injury claim against that party in addition to receiving workers’ compensation benefits. If your claim is denied by the insurance company, you have the right to request a hearing before an administrative law judge at the State Board of Workers’ Compensation.
Contact Hansford McDaniel, Workers’ Compensation Attorneys
Understanding who pays for workers’ compensation is just the first step in protecting your rights after a workplace injury. The insurance company’s goal is to minimize what they pay, and without experienced legal representation, you may not receive the full benefits you deserve. Our team at Hansford McDaniel examines every claim in depth and fights to make sure injured workers throughout Georgia receive the care and financial support they are entitled to. With a Super Lawyers recognition spanning more than 10 years and numerous million-dollar results, we have the knowledge and resources to hold insurance companies accountable.
If you have been injured at work and have questions about who is responsible for paying your workers’ compensation benefits, call us at (770) 922-3660 to schedule a free consultation, or reach out through our contact form to get started today. We treat every client like family, and we will not rest until you receive the compensation you deserve. Se habla español.
