What Is The Maximum Settlement Amount for My Georgia Workers' Compensation Claim?

Do you want to know how much your Georgia Workers' Compensation claim should settle for? The truth is you need to know two things. First, the adjuster will never offer you as much as the case is worth, so attempting to negotiate a settlement on your own, in most cases, could cost you thousands of dollars. Second, hiring the right man for the job is always the most important thing for any task, and settling your workers' compensation claim is no exception. You should consult with an experienced Georgia workers' compensation attorney prior to signing anything - even if it is for a free initial consultation (just about every lawyer offers them). You can read my post on how to find an experienced workers' compensation attorney by clicking here.

My hope is that this article will help you get an idea of what all goes into a fair settlement. Remember, using this blog to calculate your settlement amount is a very bad idea because I haven't had the chance to talk to you and ask you questions, and not every aspect of every case can fit neatly into the following three categories. No attorney-client relationship can exist just by reading my blog, so please read the rest of this post and give serious consideration to calling an experienced Georgia workers' compensation attorney before you sign anything

Settling your Georgia Workers' Compensation case involves taking into account several different factors. First, there are your lost wages which are called temporary total disability or temporary partial disability benefits in workers' comp. A good settlement will include any past-due workers' compensation indemnity benefits (lost wages), plus late penalties if applicable, and a realistic estimate of future temporary total disability or temporary partial disability benefits.

Second, your medical treatment, both past and future, needs to be accounted for. These expenses could inclue surgery, medical mileage, prescriptions, physical therapy, rehabilitation supplies, pain management, x-rays, CT Scans, MRI's, EMG's, injections, spinal cord stimulators, and follow-up appointments with an orthopedist, neurologist, or a neurosurgeon - the list goes on and on. You may also need to obtain a Medicare Set Aside account in certain circumstances, and failing to do so when it is necessary could potentially result in Medicare denying you medical treatment in the future. 

Third, assuming this is not a death claim and you are not catastrophically disabled, then the last thing you want to consider is your permanent partial disability rating associated with your Georgia Workers' Compensation injury. Generally speaking, a PPD rating is issued by your doctor once you reach maximum medical improvement. For a great article explaining PPD ratings, read my prior blog post entitled "What is a Permanent Partial Disability Rating and How Do I Know What Mine Is?" by clicking the link. That rating is then multiplied by a certain number of weeks depending on what body part the injury involved as discussed in my prior post. 

There are, of course, additional factors to consider when settling a workers' compensation case not discussed here. For instance, if you also had a Title VII employment discrimination case against the Employer, you need to be extremely cautious in signing anything as the settlement documents will undoubtedly release or discharge the employer from any other potential lawsuit. Additionally, please know that you do not get pain and suffering in workers' compensation cases, so do be realistic in your expectations regardless of how significant your injury is.

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What Is a Permanent Disability Rating and How Do I Know What Mine Is?

 Dear Mr. Hawkins: An insurance adjuster said to me that my permanent disability rating was about 10% and that entitled me to $5,000. What is a permanent disability rating and how do I know they are telling me the truth? -Craig, Thomasville, GA

Thank you for your question Craig. I imagine this particular adjuster threw this number at you as a settlement offer? If so, do not sign anything and do not accept this amount without talking to an experienced workers' compensation attorney. Permanent partial disability is another benefit injured workers are entitled to under the Georgia Workers' Compensation Act that insurance adjusters do not want you to know about. About the only time they will tell you about permanent partial disability, or PPD for short, is when they want you to settle the case and they know you are unrepresented by counsel. 

A permanent partial disability rating, or "PPD" rating, should be issued by the authorized treating physician when the injured worker reaches maximum medical improvement or "MMI." MMI does not occur until your doctor, or medicine in general, has nothing left to offer you to make you better. The rating is a percentage of permanent impairment the injured worker has sustained as result of the workers' compensation accident. It is often issued either to the body part injured or to the body as a whole. For example, one may sustain a 40% impairment rating to the body as a whole for a serious leg injury or an 85% impairment rating to the lower extremity. Under Georgia law, the percentage is then multiplied by a certain number of weeks under the Georgia Workers' Compensation Act. The Code section which provides these numbers is O.C.G.A. Sec. 34-9-263 which can be viewed by the public for free here. That number is then multiplied by the injured workers' comp rate (which is the same as the injured workers' temporary total disability rate - see "How Much Do They Owe Me? Calculating Your Workers' Comp. Check in Georgia."  article on this site). That amount is how much money an injured worker is entitled to under the Georgia Workers' Compensation Act for their PPD rating; however, that is not the full extent of the value of the case, and you should not settle your case for that amount.

An experienced workers' compensation attorney will review the doctor's permanent partial disability rating and compare it to the American Medical Association's Guides to the Evaluation of Permanent Impairment, 5th Ed. to ensure the injured employee is receiving a fair rating. Additionally, an experienced workers' compensation attorney will review your average weekly wage to ensure your comp rate is accurate under the law. Often, the insurance company makes a mistake or intentionally miscalculates your average weekly wage to save money. Several other factors need to be considered when settling a case for a lump sum settlement. These other factors will have a significant impact on how much you are entitled to under the Georgia Workers' Compensation Act. If you have sustained a work-related injury, and have been offered a settlement based on the insurance company's estimated average weekly wage, comp. rate, and/or permanent partial disability rate, I recommend you talk with an experienced workers' compensation attorney prior to accepting or signing anything. If you would like to discuss your case with me at no obligation, please feel free to call either one of our offices today. The consultation is always free and will remain confidential until you instruct us otherwise. 

Common Shoulder Injuries in Workers' Compensation Cases

One of the most common injuries I see as a Georgia workers' compensation attorney are shoulder injuries. Given that most employees are constantly using their arms for heavy or repetitive lifting, I am never surprised to get a new shoulder case. Sudden movement of the arm can cause a dislocated shoulder, torn rotator cuff, partial rotator cuff tear, and so on. Shoulder pain is a serious symptom that should be taken seriously because early intervention can reduce the risk of further tearing of the cuff and permanent partial loss of the upper extremity.

The reason why the shoulder is so vulnerable to injury is because the ball of the upper arm is larger than the socket, and often the ligaments, tendons, and muscles which hold your shoulder in place are damaged from repetitive activities or over extension of the arm. This can cause the ball to literally come out of the socket and damage the shoulder. The most common shoulder injuries include strains, sprains, dislocations, separations, tendinitis, bursitis, torn rotator cuffs, frozen shoulder, fractures, and aggravation of preexisting arthritis (which is also compensable under the Georgia Workers' Compensation Act). While the tendons can be a source of the pain, the muscles around the socket are usually the root cause of a serious shoulder injury and the most commonly injured rotator cuff muscles are the supraspinatus and infraspinatus muscles.

Doctors will usually treat shoulder injuries with conservative treatment first. Conservative treatment consists of rest, ice, compression, and elevation (RICE) until an exact diagnosis can be given. In some cases, physical therapy and injections into the shoulder may relieve the pain; however, if conservative treatment fails, an MRI of the shoulder should be ordered by the treating physician to examine the joint for significant damage. More aggressive treatment usually includes surgery to repair the shoulder if a rotator cuff tear or a partial rotator cuff tear can be identified on MRI. In rare cases, a surgeon may perform exploratory surgery if an MRI is negative, yet pain persists and the injured worker has a loss of their range of motion. 

The road to recovery for serious shoulder injuries can be long and difficult. Injured employees must be patient and follow their doctor's orders to obtain the best results. However, in many cases the shoulder never returns to pre-injury status and use of the upper extremity is occasionally permanently restricted.

 

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How Much Do They Owe Me? Calculating Your Workers' Comp. Check in Georgia

In Georgia, determining how much you should receive each week when you have sustained a workers' compensation injury and are unable to work begins with determining your average weekly wage. This is a tricky issue that often requires the assistance of an experienced workers' compensation attorney because a number of factors from uniform allowance to how many hours you worked per week can come into play.

To begin, review your wage records from the thirteen weeks prior to the week of your injury. You should utilize your gross pay (before taxes, insurance, etc. are taken out), not your net pay (what your actual paycheck is.)  Not counting the week of your injury, look to see if you worked the majority of the 13 weeks preceding the date of the injury. If you worked substantially the whole of the 13 weeks, add up your pre-tax weekly wages for those 13 weeks, and divide that number by 13. That is your average weekly wage. To determine how much your weekly benefit should be, divide that number by 1.5. That amount should be how much you are paid each week if you have been taken completely out of work by your doctor. For example, if your average weekly wage is $600, your weekly check should be $400. Note, the current cap on temporary total disability weekly benefits is $500.

If you are working reduced hours or at a lower rate of pay because you were placed on light-duty restrictions by your doctor, you will be receiving temporary partial disability benefits and your check should be equal to two-thirds of the difference between your pre-injury wage during the 13 weeks prior to your injury, and your actual weekly pay while working on light-duty.

 

 

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Independent Medical Exmainations: Knowing Your Rights Under the Georgia Workers' Comp Act

Often, I am told by my clients that they do not agree with their doctor's opinion regarding their diagnosis, work restrictions, and treatment options. I am never surprised to hear this because with workers' compensation, you are usually only allowed to select a physician from a list of 6 doctors the employer and/or insurance company has pre-screened for their practice tendencies and willingness to cooperate with the attorney or nurse case manager who represents the interests of the employer or insurer. Furthermore, employees are often skeptical of doctors who are selected by their employer because they do not know the doctor's reputation or feel they have not been treated fairly.

With that being said, the overwhelming majority of doctors who are on panels will not be persuaded by the insurance company's attorney or nurse. There are good doctors on employer's panels. The majority of doctors will do the right thing, and give an honest assessment of the injured workers' symptoms, diagnosis, treatment options, and ability to return to work. Therefore, the decision to request an IME should be considered carefully.  

When a client desires to have an independent medical examination or IME, certain requirements must be met under the Georgia Workers' Compensation Act for the insurance company to be financially responsible for a Claimant's one-time IME. O.C.G.A. Sec. 34-9-202 (e) (the applicable law) requires that the case has been accepted as compensable, meaning the employee has received money for their lost time from work, and the injured worker must have received a check within the last 120 days at the time of the appointment.  So, if an injured employee's case has not been accepted as compensable, it is often very difficult to arrange for a second opinion; however, other options are available. (The employee can pay for an IME or the attorney can pay for it as part of the expenses of litigation.)

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