Nursing homes and other personal care facilities have grown in number as the population has aged. These facilities employer many different types of nurses including:
- Registered Nurses (RNs)
- Licenses Practical Nurses (LPNs)
- Certified Nursing Assistants (CNAs)
Working in a nursing home can often be physically demanding as many residents need assistance with many daily activities. Nurses often help residents get in and out of bed, into and out of seating, and with toileting and bathing.
Lifting or helping move residents can be dangerous. Nursing home employees can also be exposed to other dangerous conditions such as slippery floors and dangerous equipment. These dangerous conditions can cause injuries.
While some of these injuries are minor and resolve after a few days, many injuries can be more serious. These more serious injuries may require extensive medical treatment and testing. They often also prevent the injured person from returning to work for some time.
Workers compensation provides coverage for medical bills and time out of work when workers suffer on the job injuries. But, there are limits on what benefits are available and rules that must be followed. Nurses and other employees who suffer injuries while working in a nursing home need to understand what workers compensation covers and how to get answers to questions about workers compensation.
What benefits does Georgia workers compensation provide to nursing home employees who are hurt at work?
Georgia’s workers compensation law provides three basic types of benefits to nursing home employees who suffer an on the job injury. Those benefits are:
- Wage loss benefits
- Medical benefits
- Permanent partial disability benefits
Before discussing those benefits further, it is important to understand that different states have different workers compensation laws. If your workers compensation claim is being handled under the laws of a state other than Georgia, the information below will not apply to you. There are situations where it can be difficult for you to determine what state’s law apply to your workers compensation claim and what state you can file in. The best thing to do in this situation is reach out to an attorney for a free consultation as soon as possible to make sure your claim is being handled correctly and you do not miss deadlines.
Wage loss benefits
Georgia’s workers compensation law divides wage loss benefits into two types – temporary total disability and temporary partial disability. Workers compensation pays temporary total disability benefits when an injured worker is unable to work as a result of a work-related injury. Temporary partial disability benefits are paid when an injured worker can work but they are earning less because of their injury.
These wage loss benefits do not start immediately after an injury. There is a waiting period and the insurance company has time to investigate your case before the benefits become due. This investigation period provides the insurance company the time to decide if they are going to agree that you got hurt at work or instead choose to deny your case.
When the wage loss benefits start, the insurance company should pay all wage loss benefits due up to that time. After that, benefits should be paid on a weekly basis as long as you are eligible to receive them. Georgia’s workers compensation law provides various reasons that the insurance company can stop your wage loss benefits.
One other important thing to understand is that workers compensation does not pay the full amount of your wage loss. In most cases, it pays two-thirds of your lost wages. But, there are also maximum amounts which apply that result in the workers compensation insurance company paying less than two-thirds of lost wages in certain situations. These two articles provide a more detailed explanation of workers compensation wage loss benefits:
Medical benefits
One of the main benefits of workers compensation is payment for the medical treatment and testing for a work-related injury. Georgia workers compensation covers one hundred percent of the cost of medical treatment for the work-related injury, so you do not have a copay or deductible. But, there are rules you must follow and limits that apply.
One rule is that you usually cannot treat with any doctor you want. You usually have to pick a doctor off a list of doctors provided by your employer. This list is known as the panel of physicians.
The doctor you select off the panel of physicians becomes your authorized treating physician. Your authorized treating physician can treat you, order testing, and refer you to specialists. The authorized treating physician also has a lot of power to make decisions that affect whether you continue to get benefits.
A second rule is that your treatment has to be related to your injury for the workers compensation insurance company to be responsible. If the treatment is not related to your injury, the insurance company may deny payment.
A third rule is that the insurance company only has to pay for reasonable and necessary treatment. Workers compensation insurance companies often challenge whether medical treatment is reasonable and necessary, especially when the treatment is more expensive.
A fourth rule limits how long the insurance company has to pay for medical treatment and testing. If your injury occurred after July 1, 2013, the insurance company only has to pay for medical treatment for up to 400 weeks in most situations. There are exceptions to this 400 week limit that can apply based on the type of medical treatment or the type of injury.
Permanent partial disability benefits
Permanent partial disability benefits are the way that workers compensation compensates you if you have a permanent loss of function as a result of your injury. This means that you do not have a one hundred percent recovery.
If you have a permanent impairment, your authorized treating physician should give you a permanent partial disability rating. Georgia law requires doctors to use the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 5th Edition, when assigning your permanent partial disability rating.
If you receive a permanent partial disability rating, you should ultimately receive payment for that rating. The number of weeks of benefits you get paid will depend on how high your rating is. The timing of the permanent partial disability payments will depend on when your other benefits stop. This article provides a more detailed explanation of how permanent partial disability payments work.
How do I file for workers compensation benefits after a nursing home injury?
In most cases, all you should have to do is give notice to your employer of your injury. Under Georgia’s workers compensation laws, notice could be oral or written. You do need to make sure that you do it as soon as possible after your injury because there is a time deadline for giving notice. Also, make sure to give notice to a supervisor.
The safest thing to do is provide the notice in writing. Texting and emailing can be great options for providing notice because you have the evidence showing your provided the notice if your employer tries to dispute that you provided notice.
Usually, once you provided notice, your employer should work on getting you authorized to see a doctor and your claim will simply move forward. However, if your employer denies your claim, you will need to file paperwork to pursue your claim.
The most common way of doing this is filing a WC-14 to request a hearing. There are deadlines for when you have to file this form. The shortest deadline is one year from the date your were injured. If your claim is denied, be sure to talk to a workers compensation attorney because there are special rules that apply to be able to prove your case to a workers compensation judge.
What happens if my injury prevents me from ever returning to my regular nursing home job?
Some serious injuries result in permanent impairment and restrictions on what you can do. Many nursing home jobs require lifting, walking, kneeling, squatting, and other physically demanding tasks. When serious injuries limit your ability to do these tasks, they will probably prevent you from returning to work at your regular job.
When this happens, the workers compensation insurance company should pay wage loss benefits while your injury keeps you out of work. But, Georgia’s law provides limits on how long the insurance company has to pay these wage loss benefits. So, you must worry about them running out at some point.
Also, the workers compensation insurance company will likely try to stop the wage loss benefits before they run out. One of the most common ways to do that is for them to offer you a “light duty” job. Georgia’s workers compensation law has special rules that apply to “light duty” job offers.
Settlement is another topic that many people explore when they cannot return to work at their regular nursing home job. Settlement is a very complex topic. Take a look at this article for some helpful information about what a workers compensation settlement is and some of the things that need to be considered.
What if I get denied workers compensation benefits because the nursing home says I did not lift properly?
One common tactic of nursing homes and other employers in recent years is to try to deny payment of workers compensation benefits on the grounds that the injured worker violated a safety rule or did not use a safety appliance. This defense often comes up with nursing home lifting injuries.
The employer or insurance company will claim that the employer’s rules require multiple people to lift in certain situations or require the use of assistive devices like a Hoyer lift. The argument is that the injury would not have occurred if the injured worker would have followed the employer’s rules.
There is a part of Georgia’s workers compensation law that allows this defense by the employer. But, the employer has to prove very specific violations to succeed in this defense. So, do not give up on your right to pursue benefits if your employer or the workers compensation insurance company says they are denying your claim for violation of a safety rule.
