If you have been injured on the job, your most immediate concern may be dealing with your loss of income. Medical treatment matters, of course, but the question that keeps my clients up at night is simple:
“How am I going to pay my bills if I can’t work?”
Georgia’s workers’ compensation system does provide wage-replacement benefits, but those benefits are not automatic and they do not fully replace your pre-accident earnings. Understanding how and when an insurance company decides whether to “pick up” a claim can reduce uncertainty and help you know what to expect.
What Does It Mean When an Insurance Company “Picks Up” a Claim?
In workers’ compensation terms, an insurance company (or self-insured employer) “picks up” a claim when it accepts the injury as compensable and begins paying benefits voluntarily.
This usually means:
- The insurer accepts that the injury arose out of and in the course of employment, and
- The insurer agrees that the injury is causing lost time from work.
If your employer and their insurance company decide to pick up your claim they are supposed to send you a form called a WC-2. This form will show that benefits have been commenced, the date of the first check and whether a late payment penalty is included.
The WC-2 form will also include the weekly payment rate and the “average weekly wage” number used for this calculation.
What constitutes your “average weekly wage” is a topic for another article but in general, your employer must look at your gross (before tax) earnings from the 13 weeks immediately preceding your injury. If you have not worked for 13 weeks prior to your injury or if you have worked for multiple employers then a different calculation is used.
Under Georgia workers compensation law you are entitled to 2/3 of your average weekly wage with a maximum of $800 per week. This maximum applies to work accidents that occured after July 1, 2023. If your date of injury is before July 1, 2023 the maximum weekly wage benefit will be lower. Hopefully the Georgia legislature will see fit to increase this maximum TTD (temporary total disability) benefit in years to come.
When Do My Weekly Wage Benefits Start?
Under Georgia law your employer (and their insurance company) has a limited window of time to investigate the details of your work injury and to make a decision whether to pick up your lcaim and start paying benefits, or to deny (“controvert”) your claim.
In most cases, your employer (and their insurance company) has 21 days from the date it learns of the injury and disability to either:
- Begin paying weekly income benefits (Form WC-2), or
- Officially deny (controvert) the claim (Form WC-3)
This investigation period allows the insurer to:
- Review accident reports
- Obtain medical records
- Take statements
- Decide whether it believes the claim is work-related and disabling
This is why it is so important to report your work injury as soon as you can. Further, our experience has been that delays in reporting work injuries increase the likelihood that the insurance company will controvert (deny) your claim.
When Must the Insurance Company Start Paying Lost Wage Benefits?
If the insurer accepts the claim:
- Weekly income benefits must begin no later than the 21st day after the employer has knowledge of the injury and disability
- Payments are typically made weekly
- Benefits are paid at two-thirds of the worker’s average weekly wage, up to the Georgia maximum (for injures incurred after July 1, 2023 the maximum is currently $800 per week)
There is also a seven-day waiting period before income benefits are payable. However:
If your disability lasts more than 21 days, the first seven days are paid retroactively.
How Will the Worker Know If Checks Are Coming?
- You should receive a completed form WC-2 in the mail
- You contact the posted panel doctor and you are able to schedule an appointment
- Your attorney hears from the insurance company that your claim has been picked up.
What are the Signs that my Work Injury Claim has been Denied?
- The insurer files a Notice to Controvert with the State Board of Workers’ Compensation (Form WC-3) and sends you a copy
- No checks arrive after the investigation period
- Medical care is refused or cut off
Silence alone can be confusing. Unfortunately, some workers hear nothing at all during the investigation period, which adds to financial stress.
As your attorneys we can contact the employer and/or their insurance company to answer questions they may have about your case and to advocate on your behalf and encourage the insurer to pick up your claim.
What If No Checks Arrive?
If income benefits do not begin within the required time frame, you must take action. Under the law you can
- Challenge the insurance company’s decision to controvert benefits (and request a hearing before the State Board of Workers Compensation)
- Seek penalties for late payment
Delay does not necessarily mean the claim is invalid—but it does you need to take action. In our office we have seen many cases where, without any good reason, the insurance company did nothing and our client (before hiring us) just waited week after week. Don’t let this happen to you.
Loss of income is one of the most stressful parts of a work injury. Georgia law sets strict deadlines for insurance companies to investigate and either pay or deny a claim, but those rules will not necessarily be explained to you. If you sense that you are getting the run around or that your claim is gathering dust on a desk somewhere we encourage you to call our office at 770-351-0801 to get things moving.
The post When Will I Receive my First Lost Wage Check from the Insurance Company? appeared first on Georgia Workers Compensation blog.
