The workers’ compensation process can be a long, stressful, and confusing legal process. Thus, hiring an experienced workers’ compensation attorney can help alleviate many of the burdens that occur throughout your claim. New clients have many questions when their claims first begin, one of the most common questions we receive is “Do I receive any weekly income as a result of being out of work, and if so, when and how much?”.
First and foremost, your workers’ compensation claim must be deemed “compensable” by the insurance company in order for you to receive any weekly benefits. A compensable injury is an injury or ailment that you suffered as a result of an on-the-job accident. If your case is compensable, then you are sent by the insurance company to treat with an Authorized Treating Physician (a doctor authorized by the insurance company to treat you for your on the job injury).
In order to receive weekly benefits, your injuries or ailments related to work accident must prevent you from working. If the authorized treating physician has placed you on a no work status or a light duty work status/light duty work restrictions, but your employer cannot accommodate these restrictions, then you are entitled to receive a weekly check paid by the Workers’ Compensation Insurance Company. Georgia Law allows for two different types of weekly benefits, Temporary Total Disability (TTD) benefits and Temporary Partial Disability (TPD) benefits; you may not receive both at the same time. TPD benefits are discussed in a different post. Temporary Total Disability (TTD) benefits are benefits due to an injured worker when his or her earning capacity has been totally impaired. In other words, he or she cannot return to work and cannot earn any income because of the on-the-job injury.
Temporary Total Disability benefits are considered “temporary” because they are subject to a cap in Georgia. An injured worker in Georgia can only receive Temporary Total Disability checks for a maximum of 400 weeks from the date of injury (DOI). The TTD rate is calculated using the injured workers Average Weekly Wage (AWW). To determine the injured workers Average Weekly Wage, the insurance company will add 13 weeks of pay and then divide this number by 13 to obtain the Average Weekly Wage. So, what happens if you have not received 13 weeks of pay from your employer? In this case the insurance company would use numbers from a similar suited employee. Your TTD rate would be 2/3 of your Average Weekly Wage. Under Georgia Workers’ Compensation laws there is a maximum compensation rate for Temporary Total Disability. Currently (as of the date this article was written) the maximum an injured worker can receive regardless of his Average Weekly Wage (AWW) is $575 per week.
When Do You Receive Your TTD Check and What If Your Check Is Late?
In order to know when you are to receive your check and whether it is late, you must first determine where the insurance company is mailing your check from and what weekly pay period the check covers. The easiest way to answer where this check originates from is to look at the insurance company’s address on the envelope and on the check. You can also look to see if a Georgia postmark appears. Also, the check/check stub should show the pay period. The pay period shows what week the check covers. For example, the check might say “Temporary Total Disability 12/01/18 to 12/07/18.” That indicates the check pays the period from 12/01/18 to 12/07/18.
If the check comes from Georgia, the insurance company must mail the check by the last day of the pay period. Thus, a check paying the period of 12/01/18 to 12/07/18 must be mailed by 12/07/18. If the insurance company mails the check after 12/07/18, the check will be considered late. You can determine when the check was mailed by looking at the post mark on the envelope and the date on the check, yet the insurance company still does have a loophole of sorts to argue that they did not send the check out late.
The Georgia Workers’ Compensation law only says the insurance company will be penalized if they do not mail the check out within the regulated time by Georgia law. The law does not hold insurance company accountable for what happens once the check is mailed. For example, you have not received your check in the time frame allotted by Georgia law. First, you should call the insurance company or if you are attorney represented, call your attorney’s office to verify the insurance company did indeed mail the check in a timely manner. If confirmed the check did go out in a timely manner, you should discuss your options regarding having a stop payment placed on the lost check and having the check reissued as soon as possible. If it is determined the insurance company was negligent in mailing the check in a timely fashion, then you will be due a 15% penalty in addition to the weekly check amount. For example, if your weekly TTD check is at the max rate of $575.00/week and the check did get mailed late, then you would still be entitled to that week’s $575.00 check plus an additional $86.25, which is 15% of $575.00.
Again, trying to understand and decipher all this information along with having an injury can be overwhelming. Thus, we here at The Larrison Law Firm want to extend a hand in guiding you through this process. My staff and I would be happy to setup a free consultation to discuss the details of your individual case and needs.