Is Workers’ Comp Insurance Worth the Investment?
Georgia attorneys explain how worker’s comp works and why it’s important to have insurance coverageBy David Levine | Reviewed by Canaan Suitt, J.D. | Last updated on February 2, 2024 Featuring practical insights from contributing attorneys Gregg M. Porter and Darrell Sutton
Use these links to jump to different sections:
- Georgia’s Workers’ Compensation Law
- The Three Basic Benefits of Worker’s Compensation Coverage
- How Workers’ Comp Gets Calculated
- Things That Aren’t Covered Under a Georgia Workers’ Comp Policy
- Who’s Required to Have a Workers’ Comp Policy?
- Workers’ Compensation Insurance Costs Tend to Pay for Themselves
- Find an Experienced Workers’ Compensation Lawyer
Workers’ compensation claims in the state of Georgia are usually pretty straightforward. Here’s one that wasn’t.
An employee reported that he injured his back at work. The employer (a food/agriculture business) and its insurance company accepted the claim and paid him for lost time and medical treatments, including lumbar fusion. But six months later, when the employee stopped complying with his medical care, the case was sent to Gregg M. Porter of Savell & Williams in Atlanta.
“We then discovered that the employee had a history of lumbar issues, some as far back as 20 years, and some very recent, for which he sought medical treatment just a few months before the alleged accident,” Porter remembers. “Of note, he specifically denied in his deposition that he had any lumbar medical treatment or issues prior to his alleged accident. It was also discovered that the employee lied on his post-hire medical questionnaire, specifically denying prior lumbar problems and medical treatment.”
The claimant’s lawyers eventually dropped any claim for future benefits, and the case was turned over by the employer and insurer to the enforcement unit at the State Board of Workers’ Compensation. “After the fraud was discovered, I asked the employer what he wanted, and he said, ‘I want him to go to jail,’” Porter says. And that’s what happened. The claimant was prosecuted for insurance fraud under the Workers’ Comp Act and spent several years in prison.
Georgia’s Workers’ Compensation Law
This case, though extreme, shows why legal representation can be so important in workers’ comp claims. Every state creates its own rules; under Georgia state law, workers’ comp is a no-fault system designed to provide specified benefits for work-related injuries for any reason.
“It can be a traumatic event—a warehouse pallet falls on you, you’re run into by a forklift—or a repetitive trauma like carpal tunnel syndrome,” Porter says.
The Three Basic Benefits of Worker’s Compensation Coverage
The “ultimate purpose” of workers’ comp is to ensure that someone injured on the job can return to work, says Darrell Sutton of Sutton Law Group in Marietta. Workers’ comp insurance provides three basic benefits:
- Coverage for any medical expenses;
- Weekly compensation while the worker is unable to work; and
- Partial permanent compensation if there is some reduction in the use of a body part.
“For example, say I had a knee injury, and after treatment, it’s only about 90 percent as good as it was before the injury. It would compensate me for that loss if it had been work-related,” Sutton says.
How Workers’ Comp Gets Calculated
Lost-wage compensation is worth two-thirds of wages but capped at $800 per week, Porter adds. Permanent impairment compensation is a calculation based on the rate of impairment—say 10 percent (as in Sutton’s example) times the number of weeks specified in the code, times the workers’ comp rate. This is also capped at $800 a week. There are no “pain and suffering” allowances.
Things That Aren’t Covered Under a Georgia Workers’ Comp Policy
There are exclusions to workers’ comp coverage, of course. If you experience a workplace injury but were intoxicated or in violation of company rules or regulations, that would not be covered. If you’re injured taking a personal detour while driving for work, you’re not covered.
“In Georgia, there are also exceptions for having a heart attack or stroke [on the job],” Sutton says. “The presumption is it doesn’t count unless you can provide some affirmative medical evidence proving otherwise”—that is, that it was brought on by the work itself.
Who’s Required to Have a Workers’ Comp Policy?
Any Georgia business with three or more employees is required to have workers’ comp insurance, but the cost depends on the type of business. “If it’s an office business, it’s not costly. If it’s a manufacturing facility, it costs a lot,” Porter says. Like auto insurance, your personal history affects your premium.
Sutton says small business owners and decision-makers should “remain mindful that decisions about handling a workers’ compensation claim should always be business decisions. Where I have seen clients encounter trouble is when they make those decisions based upon emotion rather than upon objective monetary calculations.”
Workers’ Compensation Insurance Costs Tend to Pay for Themselves
Sutton also stresses that a workers’ comp policy will invariably pay for itself over time. “It’s cheap relative to other insurance, and it can save you even if a claim is not legitimate,” he says.
“Across my 20 years of practice, I have time and again represented businesses that decided to save money on the front end by not purchasing workers’ compensation insurance, only to pay multiple times the cost of that premium when a workers’ claim is filed and they have to defend against it. The attorney’s fees associated with defending a claim nearly always exceed the workers’ compensation insurance premium that the business avoided—not to mention the cost to resolve the claim. Both would have been paid by an insurer had they purchased the insurance in the first place.”
Find an Experienced Workers’ Compensation Lawyer
Visit the Super Lawyers directory to find an experienced workers’ comp lawyer in your area for legal advice. For additional information on this area of law, see our overview of workers’ compensation law.
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