If you are reading this article, you have probably received notification that the Georgia Insurers Insolvency Pool has taken over handling of your workers compensation case. That notification probably left you with a lot of questions.
Before that happened, your workers compensation benefits had probably been paid by an insurance company. Now, that insurance company is insolvent. That means the insurance company does not have enough assets to cover its liabilities..
Then, the Georgia Insurers Insolvency Pool comes in. This article will address what the Insolvency Pool is and how their involvement will affect your workers compensation case.
What is the Georgia Insurers Insolvency Pool
The Georgia Insurers Insolvency Pool is a nonprofit legal entity. The Pool was created to address the issue of what happens when an insurance company goes insolvent and can no longer pay its claims. One of its primary purposes is to assure that these claims are still paid.
The Insolvency Pool is not just limited to workers compensation claims. It covers automobile accident claims and other claims as well for insolvent insurers.
The Insolvency Pool needs money to operate. The law creating the Pool makes insurance companies pay into the Pool to makes sure there are funds available when an insurance company goes insolvent.
Is there a delay when the Insolvency Pool takes over my workers compensation case?
The Insolvency Pool becomes involved in a case when an insurance company is declared insolvent. However, there is almost always a delay when the Insolvency Pool takes over a workers compensation case.
This delay occurs because the Insolvency Pool has to get information about all of the workers compensation claims that the insolvent insurance company had open. It then has to assign these claims to adjusters that work at the Pool. The Insolvency Pool also has to investigate whether each claim will be covered by the Pool.
This delay can cause problems with your workers compensation benefits. If you are receiving weekly workers compensation benefits, the insolvent insurance company will usually issue a check for several weeks worth of benefits to cover the time that it takes the Insolvency Pool to process and investigate the claim.
Delay can be more of a problem with medical treatment. Since most medical providers want authorization before providing treatment, you could have an issue getting medical treatment until the Insolvency Pool officially takes over your claim.
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Does the Insolvency Pool pay the same workers compensation benefits that the insurance company does?
Generally, the workers compensation benefits paid by the Insolvency Pool are the same benefits as those paid by insurance companies. They pay:
- Wage loss benefits (temporary total or temporary partial disability)
- Medical benefits
- Permanent partial disability benefits
There are some benefits that the Insolvency Pool does not cover in workers compensation claims. For example, the Insolvency Pool does not have to pay accrued assessed attorneys fees or accrued late penalties. The statute that created the Insolvency Pool provides that those accrued benefits are not part of the “covered claim”.
Does the Insolvency Pool cover all workers compensation claims?
No. Not all workers compensation claims are covered by the Insolvency Pool. The statute that creates the Pool defines which claims are covered.
One of the most common reasons that a claim is not covered by the Insolvency Pool has to do with the net worth of the employer. If the employer’s net worth exceeds a certain amount, then the Pool does not cover the claim. This means that the employer becomes responsible for paying workers compensation benefits.
The current threshold for net worth is 25 million dollars. When an insurance company goes insolvent, the Pool will mail a letter to employers who have active workers compensation claims with that insurance company. These letters request financial net worth information from the employers.
If the employer does not respond to that letter and provide the request information, then the Pool will generally deem the employer to be worth over 25 million dollars and not cover the claim. When this happens, it can make it difficult to receive the workers compensation benefits you should since your employer is not accustomed to handling workers compensation claims and paying benefits.
If your employer does fail to respond to the net worth request letter, there is a possibility that you may still be able to get the issue straightened out and get the Pool to cover your claim. But, you will probably have to demonstrate to the Pool or to a judge that your employer’s net worth is less than 25 million dollars.
Can I settle my workers compensation case with the Georgia Insurers Insolvency Pool?
Yes. For the most part, the Georgia Insurers Insolvency Pool acts like an insurance company. They pay benefit. They also settle claims.
If you are considering settlement, you will want to make sure that it is a good time to settle your claim. You should also make sure that you make a good decision about what amount you should settle your case for. If you would like to learn more about settlement, this article I wrote discusses many of the different issues that can come up with workers compensation settlements.
What if I want help dealing with the Insolvency Pool?
Many people have questions about workers compensation. When the Insolvency Pool comes into your case, it can create a whole different set of questions.
I believe it is important to get answers to your questions. Getting these answers helps you make good decisions. Talking to a workers compensation attorney is a good way to get answers.