Eligibility & Benefits
Many Workers’ Compensation claims are cut and dry. You are injured at work; you report it to HR; your company files your claim; and you receive benefits to recover lost wages and pay for medical treatment. When you are well, you return to work.
But what happens when your healing takes a long time? Or when your injury is one in which there is no full recovery from? That’s when the catastrophic injury section of Workers’ Compensation coverage comes into play.
In 2013, the Georgia Workers’ Compensation law changed to cap temporary total disability coverage at 400 weeks from the date of the injury. That means, if you’re not well enough to return to work a year after your injury, it’s time to start checking your eligibility for catastrophic injury coverage.
There are six criteria outlined in the Georgia Workers’ Compensation Act for claiming catastrophic injury. An injured worker must meet at least one of these conditions:
An employee sustained a severe brain or enclosed head injury.
An employee has a spinal cord injury resulting in severe paralysis of the arm, leg, or trunk.
The injury resulted in the amputation of an arm, hand, foot, or leg.
The injury resulted in 2nd or 3rd degree burns covering more than 25% of the body or 3rd degree burns covering 5%or more of the worker’s face or hands.
The worker has a diagnosis of industrial or total blindness.
The employee’s injuries render him or her unable to perform his or her prior work, as well as any additional work for which he or she is otherwise qualified.
It’s most likely an injured worker knows they are eligible for catastrophic injury benefits very early on, but it is possible that one of the above criteria is met later in the healing process as injuries are treated and doctors assess long-term outcomes. And there is one additional “category” for eligibility for catastrophic injury coverage.
“In addition to the six state criteria, there is also the option to obtain an ‘unable to work’ designation from an authorized physician,” explains Gayle McFadden, paralegal at Whitehurst, Blackburn & Warren.
“But this is a very complicated process and not one to go into lightly.”
Georgia’s catastrophic injury benefits include lifetime medical treatment and weekly income (with a formulated cap), as well as rehabilitation assistance, which varies based on the type of injury and the worker’s skill set. It may also include lifestyle improvements such as assistance with remodeling your home to accommodate a wheelchair or paying for a gym membership to help progress physical therapy.“
As you can imagine, the costs associated with these life-long medical and wage benefits is steep,” says McFadden. “Insurance companies can fight these claims and many do so. That’s why working with a legal professional is so important in catastrophic injury situations.”
Whitehurst, Blackburn & Warren is ready to help navigate your Workers’ Compensation claim. Call us today at (229) 226-2161 to schedule a no-obligation consultation. The road to healing starts here.