Yes, if your claim is approved, you can indefinitely get medical, indemnity (lost wages), and rehabilitation services benefits. However, many claims will not meet the criteria for a catastrophic injury. In this article, we’ll discuss how the state of Georgia defines a catastrophic injury and how a workers’ compensation attorney can help you prove your case.
What Injuries Qualify for Catastrophic Injury Workers’ Comp?
The Georgia State Board of Workers’ Compensation recognizes these categories of catastrophic injuries:
- Spinal cord injury and paralysis. If your injury resulted in paraplegia (paralysis of the legs or the lower body) or quadriplegia (paralysis of all four limbs), this should qualify as a catastrophic injury. If the claim is found to be compensable (we’ll discuss this more later), you should receive medical and indemnity benefits for life.
- Amputation. Amputation is considered a catastrophic injury if you have lost a hand, foot, arm, or leg. Partial amputations are also considered catastrophic if you have lost the use of that limb. For example, if part of your hand was amputated and you can no longer use that hand to write, type, carry objects, or perform any of the tasks people typically do with their hands, then your amputation should be deemed catastrophic. In most cases, losing a single finger or toe is not catastrophic because it doesn’t usually cause the loss of use of the whole hand or foot.
- Blindness. This is based on “industrial blindness,” or having the eyesight of 20/200 or less as determined by a doctor. If the injured person’s eyesight is better than 20/200 with corrective lenses or other measures, then it will not be found to be a catastrophic injury. You will need a statement from your doctor attesting to your eyesight level to prove this catastrophic injury.
- Severe burns. To be assumed catastrophic, the burns should be second- or third-degree and cover at least 25 percent of the body. Third-degree burns to at least 5 percent of the face or hands will also be catastrophic. Burn injuries will also require a statement from your doctor to prove their catastrophic status.
- Traumatic brain or head injury. Not all traumatic brain injuries (TBIs) will qualify. Some TBIs are mild and don’t result in any permanent impairment. However, if your TBI caused severe sensory or motor issues, severe communication difficulties (such as being unable to speak or be understood when speaking), severe complex integrated disturbances of cerebral function, severe interruptions of consciousness (such as a coma), or a severe episodic neurological disorder, your injury may qualify as catastrophic. What counts as “severe” is not always as clear-cut as some criteria for other injuries, and the insurance company may argue that your injury wasn’t catastrophic. An experienced workers’ compensation attorney will work to prove the severity of your injuries and fight for your right to compensation.
- Miscellaneous catastrophic injuries. This grouping was created to recognize that some injuries could be catastrophic without falling into any of the above categories. The criteria for this category states that if the worker received an injury severe enough to not only prevent them from doing their previous job but also any job available in significant numbers in the national economy for which the worker would otherwise be qualified, their injury may be catastrophic. This can be problematic because the rule refers to the “national” economy, so the insurance company may argue you could still do other jobs available, even if they are not available where you live.
How Can a Catastrophic Injury Workers’ Compensation Lawyer Help?
In many catastrophic injury cases, it is not difficult to prove that the worker suffered a catastrophic injury. However, the insurance company will often try to avoid paying the claim by saying that the injury is not compensable, which usually means that it did not occur at work. They may argue that your injury happened elsewhere, especially if your accident at work was not well-documented. A catastrophic injury workers’ compensation lawyer can help you fight these claims and give you the best chance of getting the compensation you need.
In other cases, the insurer may refuse to pay your claim if they believe you were intoxicated at the time of the accident. Most employers conduct drug and alcohol tests within eight hours of a work injury for this reason, but tests are not always 100 percent accurate. If you believe that your test results were incorrect, speak with a workers’ compensation lawyer immediately.
These are only a few potential excuses an insurance company may have for denying your catastrophic injury claim. If you file a claim yourself, the insurer may try to take advantage of the fact that most workers are not experts on the workers’ compensation system. Your employer may also cause problems for your claim by failing to turn in paperwork or claiming they weren’t notified of your accident, even if they were. If you can, document your accident report to a supervisor in writing, in a way that allows you to save a copy. For example, send an email or text about the accident to your boss from a personal email account or phone number to which you can’t lose access. That way, you will always have proof that you reported the accident promptly (as soon as possible after your injury), even if your boss claims they “never got that email.”
Arguing with the insurance company after your claim is denied can also make things worse. You may think you’re convincing the insurance adjuster of your claim’s legitimacy, but the insurance company is probably recording your call. They might take anything you say out of context and claim it’s proof that their denial was justified. Don’t fall into this trap – call an experienced workers’ comp lawyer who knows the details of Georgia’s workers’ compensation laws and can determine the best way to argue your case.
What If Your Injury is Not Deemed Catastrophic?
You will still be entitled to workers’ compensation benefits, including lost income, medical care for the injury, and a rehabilitation supplier to assist you with rehabilitation services. The main difference is that these benefits will be capped at 400 weeks, while they are available indefinitely (as long as needed) for catastrophic injuries.
While this means you can receive lifetime benefits for a catastrophic injury, this is not guaranteed. Sometimes an insurance company will argue that the injured person has improved enough that their injury is no longer catastrophic, and therefore they no longer need the benefits. If this has happened, your lawyer will help you fight the insurance company to keep your benefits.
Can You Sue Your Employer If Workers’ Compensation Benefits Are Not Enough?
Workers’ compensation is a no-fault system that eliminates most personal injury claims against employers by providing injured employees with benefits through workers’ compensation insurance. In most situations, you cannot sue your employer for your injuries received at work. However, in certain situations, you may have a claim against a third party, such as a manufacturer of a defective piece of equipment that caused your injury. Your workers’ compensation lawyer can advise you if such a claim might be possible in your case. If so, you can seek remuneration for additional damages not covered by workers’ compensation, including pain and suffering and lost income beyond the two-thirds of your average weekly wage you’ll receive from workers’ comp.
Contact a Catastrophic Injury Workers’ Compensation Law Firm
If you or a loved one have suffered a catastrophic injury, don’t wait for the insurance company to do the right thing. Please contact the CEO Lawyer Personal Injury Law Firm for a free consultation about your case. Our experienced attorneys will review your claim, answer any questions you have, and explain your options.
