What Does a WC-104 Mean for Me and My Workers’ Comp Claim?

After being involved in a work-related accident, you will undoubtedly appear for medical appointments with your authorized treating physician. At some point, in most claims, prior to being released to full duty, your authorized treating physician will release you to work with light duty restrictions.  That means that you are not yet able to return to work in your full capacity, but you could return to work doing something. According to Board Rule 104, once you have received a light duty release from your authorized treating physician, the employer may, within 60 days of the light duty release, file a form WC-104.  This form allows the employer to reduce your benefits from Temporary Total Disability  (TTD) payments to Temporary Partial Disability (TPD) payments after 52 consecutive weeks of light duty release or 78 aggregate weeks of light duty release.  This form must be accompanied by the medical records placing the claimant at light duty.  It may be filed without regard to whether the employer has any light duty work available for the claimant. There is no actual requirement that the WC-104 be filed with the State Board at the time it is sent to the claimant.  Rather, it only must be filed once the prescribed number of weeks of light duty have been reached and the employer seeks to reduce benefits from TTD to TPD. Upon receipt of a WC-104, the claimant should immediately look at the date on the medical record, the date on the WC-104 and the date on the envelope.  If the WC-104 was not sent within 60 days of the light duty release, it is...

Can my unborn child receive workers compensation benefits?

Let’s imagine for a moment that an employee is injured on the job on March 25, 2003.  At that time, the employee’s wife was pregnant.  The child was born on August 5, 2003.  The injured employee dies on September 1, 2003.  Would the newborn child be entitled to dependency benefits? Yes.  While an employer will argue that the child is not a dependent because the child was not born before the date of the employee’s accident, the law states that a child includes dependent stepchildren, legally adopted children, posthumous children, and acknowledged children born out of wedlock.  Therefore, the courts have announced that any biological unborn children born after the employee’s accident are considered dependents and entitled to receive dependency benefits. On the same note, other states, including North Carolina, have stated that a child is no less the child of its father because it was born after his death.  In other words, any unborn child whether it is born before or after the employee/father dies is entitled to benefits.  This exact issue of whether an unborn child can receive benefits if born after the death of its father has not been decided before the Georgia Appellate...

What can I do if my employer ignores my request for treatment authorization?

After an employee is injured on the job, they are permitted to seek treatment with one of many authorized physicians on a panel.  In some situations, that particular authorized physician may recommend additional treatment or testing from another physician.  When this happens, the employee must file a WC-205 to request the authorization to treat with another physician. For example, employee gets injured on the job.  She reports her injury to her employer.  Employee seeks treatment with Dr. X who is an authorized physician.  After treating with the doctor a handful of times, he recommends a test that he cannot perform.  It is recommended that the employee treat with Dr. Y in order to obtain the proper treatment which will help the employee return to work.  Dr. X files a WC-205 on December 1, 2008 to request the treatment.  Unfortunately, the employer does not respond to the WC-205.  Can the employee go ahead and treat with Dr. Y or must the employee wait for her employer to give her the authorization? Since Dr. X was a valid referring physician and was authorized to treat the employee, the employer’s failure to reply to the WC-205 in five business days is a violation of Board Rules and justifies the imposition of a civil penalty under O.C.G.A. § 34-9-18/ Board Rule 205. It would be likely that an ALJ would impose a penalty between $100 and $1000 against the employer for not timely responding to the WC-205.  Failure to timely respond to a WC-205 causes an unfair delay when the employee is waiting for medical treatment. One more note, if the employee went...

Can my personal health condition prevent me from obtaining workers compensation benefits?

In a recent case, a court was asked to decide whether an employee’s obesity was the primary cause of a work injury which would have prevented the employee from receiving benefits.  The court announced that the determining factor was whether the employee was injured while performing an activity that was part of his/her job. If the employee was injured while on duty and working, then she is eligible for benefits. In this case, the employee worked for a local courthouse.  It was her job to keep the courthouse clean.  She cleaned the floors, the restrooms, and removed the trash.  One morning as she spoke to her supervisor, the employee realized that some medication that she had put in her pocket had fallen out.  Her supervisor pointed it out on the floor, so the employee walked over to it and picked it up off the ground.  As the employee bent down to pick it up, she dislocated her knee and fell to the floor.  Not only was the employee obese, but she had already undergone two surgeries to repair her knee. It was found that the pressure of the employee’s weight when she bent over caused her knee injury.  When the employee applied for workers’ compensation benefits, her employer denied the benefits based on the fact that it was her weight condition that caused her knee injury. When the claim arrived at court, the Court announced that an employee’s accidental injury must arise both “out of…the course of the employment” and “in the course of the employment”.  In other words, the accident must be: related to a risk of the...

What Happens to My Health Insurance if I Settle My Claim?

One of the major concerns any person has when leaving a job, either voluntarily or involuntarily, is what to do about health insurance.  If the employee had health benefits with the employer, there is continuing coverage available through COBRA.  This coverage is typically very expensive as it requires former employees to pay not only the contribution they were paying prior to leaving employment, but the amount equal to the employers’ share as well. Currently, and until December 31, 2009, a person who is involuntarily terminated, absent gross misconduct, will receive a 65% reduction in the premium amount for COBRA coverage.  This reduction can last for up to 9 months.  This obviously can prove very valuable to those people who are fired after being injured on the job and require medical treatment.  Many people will be able to maintain their health insurance while looking for another job. Under the terms of virtually every workers’ compensation settlement, the employee is required to resign from employment with the employer.  For most people, this means forfeiting any benefits they may have enjoyed while employed, including health insurance. Unfortunately, the guidelines for what is meant by involuntary termination in the above-listed website does not specifically address whether a resignation as requirement of a workers’ compensation settlement qualifies.  Based upon what is written, it appears that the Department of Labor would examine each settlement individually to determine whether the resignation was voluntary or...