The amount of your weekly workers compensation check is very important. You rely on this check to pay your bills when you are out of work as a result of an injury. You will want to make sure that the insurance company pays you the correct amount.
How does the workers compensation insurance company decide how much to pay me per week?
Under Georgia law, there are several different types of weekly workers compensation benefits. The Georgia Legislature and the Georgia State Board of Workers’ Compensation have created rules to determine how those weekly benefits should be calculated.
The most common way that weekly benefits are calculated is based on your earning for the three months before your date of injury. More specifically, the law requires the insurance company to use your earnings for the 13 week period before your injury.
They take an average of these earnings to determine your “average weekly wage”. As I will discuss further below, the insurance company uses this “average weekly wake” to determine the amount of your workers compensation check.
Does the insurance company have to consider all my earnings?
The insurance company should consider pretty much anything that is classified as earnings. Most obviously, this includes your gross wages on your paycheck. So, your average weekly wage is calculated based on money you earned before taxes.
Tips and other items that have a financial benefit to you should be considered as well. Some types of earnings are a little complicated. For example, reimbursement for mileage could be factored in to the extent that it exceeds the actual cost of gas and wear and tear on your vehicle.
Does the insurance company pay the full amount of my average weekly wage?
No. The insurance company only pays two-thirds of your average weekly wage in most instances. If you have an average weekly wage of $300 per week, then the insurance company would pay you $200 per week in temporary total disability benefits.
In some instances, you may receive less than two-thirds of your average weekly wage if your average weekly wage is high enough. This happens because Georgia has a maximum weekly check amount.
The maximum weekly check amount varies depending on when you were injured. I have seen situations where workers compensation insurance companies use the wrong maximum check amount.
Are there other ways that the insurance company can calculate my weekly check amount?
Yes. In some situations, it would not work to use an average of what someone made in the 13 weeks before the injury. Because of this, there is a part of the law that says you only use the 13 weeks before the injury if the injured worker worked substantially the whole of the 13 weeks before the injury.
“Substantially the whole” is a fairly indefinite term which may leave room for argument. But, it basically means that a court will look at the amount of time that you worked during that 13 week period. If you missed days or weeks from work during that 13 weeks period, you may be able to argue that the insurance company should use one of the other methods of calculating your average weekly wage.
What are the other methods of calculating average weekly wage?
There are two other methods if you did not work substantially the whole of the 13 weeks before your injury. First, they look and see if there was a similar employee who did work substantially the whole of the 13 weeks before the injury. If there is not a similar employee, then the insurance company should use your full time weekly wage.
What happens if I was not working as much as usual during the 13 weeks before my injury?
I speak with people who have many different reasons that they were not working as much as usual prior to their injuries. Some of these reasons include:
- Weather (rain, snow, ice, etc.) prevented them from working
- They were sick and could not work
- Business was slow, and so they were not working as much
If you did missed a significant amount of work in the 13 weeks before your injury, you should consider arguing that the insurance company should use either a similar employee or your full time wage to calculate your average weekly wage. Otherwise, your workers compensation check amount may be a lot lower than it should have been.
Can I get my check amount changed if I believe the insurance company calculated it incorrectly?
Yes. There are a couple of different ways that you can get your check amount changed. One is for you or your attorney to contact the insurance company and try to get them to agree to change your check amount.
If they will agree, then they should file paperwork correcting the check amount. When they change it, they should also issue you backpay to correct for the incorrect checks that were issued in the past.
If the insurance company will not agree, then you may need to request a hearing in front of a workers compensation judge. At the hearing, you or your attorney can present evidence to prove what the correct check amount should be. A judge can issue an award that determines the correct amount of your workers compensation check.