How Will Your Workers’ Compensation Benefits be Determined?

If you are suffering from a workplace injury, it’s not enough to know what type of workers’ compensation benefits you may receive. You need more specific information—you need to know the value of those benefits and how your specific benefits will be determined.

State law determines what your workers’ compensation benefits should be if you are hurt at work or you become ill because of your job. However, insurance companies and employers have an interest in minimizing the workers’ compensation benefits that injured workers receive. Accordingly, it is important to know what your workers’ compensation benefits should be pursuant to the law in your state, and how to get the insurance company to provide you with the full and fair benefits you deserve.

Determining the Value of Workers’ Comp Benefits Under Georgia Law

After a work injury in Georgia, an injured worker may be eligible for the following workers’ compensation benefits:

  • Medical benefits. All of your reasonable and necessary medical expenses may be covered by workers’ compensation as long as you receive medical care from an authorized provider.
  • Mileage reimbursement benefits. You may be compensated for the cost of travel between your home and your medical provider or pharmacy. However, in order to receive this benefit you must request it. The amount that you can recover for each mile travelled varies from year to year.
  • Wage loss benefits. In Georgia, you may receive temporary disability payments if you can’t work, or can’t work as many hours as you did prior to your injury. In most cases, you may recover these benefits for no more than 400 weeks. The amount of your weekly wage loss benefit will be two-thirds of your average weekly wage. Your average weekly wage is typically the average amount that you earned for the 13 weeks leading up to your injury. However, your weekly income may not exceed the maximum amount allowed pursuant to Georgia law which was $550 per week in 2015, but is subject to change.
  • Permanent disability benefits. Permanent disability benefits may allow you to continue receiving benefits beyond the 400 weeks allowed under temporary disability benefits. Your doctor must provide an impairment rating that indicates your percentage of disability. That percentage is then applied to a set schedule of benefits.
  • Catastrophic injury benefits. Serious injuries such as spinal cord injuries, blindness in both eyes, amputations and brain damage are classified as catastrophic and may allow you to get additional benefits such as rehabilitation benefits and vocational counseling. It also removes the 400-week cap on benefits and may allow you to recover benefits for a longer period of time.

If an employee dies because of an on-the-job injury or work-related illness, his or her dependents may be able to recover:

  • Medical benefits related to the injury or illness. Any reasonable and necessary medical care that was provided because of the workplace injury or illness may be covered by workers’ compensation.
  • Burial expenses. Currently, burial expenses up to $7,500 are covered by workers’ compensation.
  • Weekly monetary benefits. A dependent, such as a child, may receive the same weekly monetary benefits that the worker would have been entitled to had he lived. A child remains a dependent until age 18 or as long as he is enrolled in school and is under age 22. If a spouse is determined to be the dependent, benefits may continue for up to 400 weeks or until the spouse is in a relationship and living with the other person, the spouse remarries, or the spouse reaches age 65. Currently, a dependent spouse may not recover more than $125,000 in Georgia workers’ compensation benefits.

While these benefits won’t bring back your loved one, they can have a significant effect on your financial wellbeing.

What the Value of Your Benefits Should Be in South Carolina

South Carolina law allows you to recover for the same types of workers’ compensation benefits as Georgia law; however, the calculation of those benefits differs. In South Carolina you may recover:

  • Medical benefits. All of your medical expenses should be covered if you are treated by an authorized medical care provider. This may include doctors’ bills, hospital bills, prescription medications and other expenses.
  • Mileage reimbursement benefits. Travel expenses may be reimbursed if you need to travel more than 10 miles round trip from your home in order to receive medical treatment. Mileage is reimbursed at the same rate as state employee mileage reimbursement. As of January 2015, that rate was 57.5 cents per mile, but it is subject to change.
  • Wage loss benefits. After seven days of being unable to work, you may recover 66 2/3 percent of your average weekly wage up to 100% of the total amount of the State’s average weekly wage established each year by the South Carolina Employment Security Commission. In 2015, the State average weekly wage was $766.05. Compensation for lost wages continues until you have medical clearance to return to work or for a maximum of 500 weeks, whichever occurs sooner.
  • Permanent disability benefits. If you have suffered a permanent disability or disfigurement because of your work injury, you may be able to recover damages according to an established schedule. You will receive a certain number of weeks of payments for your specific injury. Workers who are paralyzed or who have suffered brain damage may be entitled to permanent benefits.

Dependents may also recover for a loved one’s death if a work-related injury results in death within two years of the injury or, in the case of total disability, within six years of the injury. Death benefits pursuant to South Carolina law may be provided for people who are fully dependent on the deceased worker and include the following benefits:

  • Weekly payments of 66 2/3 percent of the worker’s average weekly wage, subject to the state maximum, for at least 500 weeks.
  • Funeral expenses, not exceeding $2,500.

Death benefits, as with other benefits, are subject to change.

A Workers’ Compensation Attorney Can Help You Get the Benefits You Deserve

If you fail to take any action after filing a workers’ compensation claim, the insurance company will determine the value of the benefits you receive. Generally, insurance companies maximize profits by paying out as little as possible in claims. Thus, insurance companies may need to be convinced to pay you the full amount of workers’ compensation you deserve.

In both Georgia and South Carolina, an experienced workers’ compensation lawyer can help you by:

  • Filing your workers’ compensation claim in accordance with state law. This includes filing in compliance with all required deadlines and with all of the required information to protect your rights.
  • Negotiating with the insurance company. Attorneys are skilled negotiators who can use evidence to persuade insurance companies to provide injured workers with the recoveries they deserve pursuant to state law.
  • Representing you during different levels of appeals. In Georgia, you may request a hearing before the State Board of Workers’ Compensation. You may be required to try mediation before your hearing. If you do not reach a conclusion at mediation or at a hearing, you may appeal to the Appellate Division of the Board. If you disagree with the decision of the Appellate Division of the Board, you may appeal to the Georgia Superior Court and state appellate courts.

In South Carolina, you may file an appeal to be heard by a commissioner of the South Carolina Workers’ Compensation Commission. The decision of the commissioner may be appealed to the Commission for review by a panel of three or six commissioners. After that, you have the right to appeal to the Court of Common Pleas and the state appellate courts.

The actions that you take now matter. If you would like more information about how to protect your rights, please call our Augusta office at 706-863-6600 or toll-free at 888-795-6261 to schedule your free consultation with workers’ compensation attorney Chris Hudson.