What to do When You Have Workers Comp Claims

workers comp claims

Hey, this is Josh Gurley, with HM Advisors and today I want to make a very special video. And this special video that we’re making is different than anything else that we’ve ever done. And so I want to make that clear from the very beginning because today I’m going to talk you through the process of what you should be thinking in the state of Georgia if you have a workers’ comp claim from the moment that employee gets injured to the moment that employee comes back to work. So let’s pretend for just a few minutes that you’re sitting at your office and somebody walks in and they say, “Hey, John was just injured out there on the manufacturing floor.” Or, “John was just injured out there on the worksite.”

What do you do? Your heart starts pumping. Your blood pressure starts going up. You start thinking to yourself, well, how bad are they hurt? What’s going on? How’s this going to affect me? There’s a hundred different questions that are running through your mind at that point in time, but the first thing you need to do is breathe and be calm. The second thing that you need to do is get the appropriate medical care to that employee as soon as possible. You want to show that employee that as an employer, you’re empathetic with them, that you want them to feel better. That you’re sorry that they were injured on the job and that you’re going to take care of them through your worker’s compensation. And that we’re going to do everything we can to get you back to work.

YouTube video

Have question? Click here to schedule a meeting with Josh!


The third thing that you need to do that is very important is you need to let the workers’ compensation company know, and you need to fill out what is called a first notice of injury form. And if you don’t have one, if you can’t find your policy then I want you to reach out to us, I want you to ask for one, or I want you to go online and you can just simply Google Georgia WC-1, First Notice of Loss report. In fact, I’ll put a link down here to the actual report for you. You need to fill that out and we need to get that to the work comp company as soon as possible.

And now that the employee is in the care of medical professionals, now that the claim has been filed, we need to make sure that the workers’ comp company has all the contact information for the injured employee. We need to make sure that that adjuster is working with that employee to help them get back to work as soon as possible. And then we need to pull out our alternate duty guide, which there’s going to be a copy of the alternate duty guide that goes along with this video, you’re going to be able to download it and going to be able to see what does an employee that’s hurt their arm, what can they do? What’s an employee that’s hurt their leg, what can they do? They’ve hurt their back, what can they do? And it’s going to give you a list of jobs that that person can do.

What we’re wanting to try to do and accomplish is get that person back to work as soon as possible, to get them doing some type of light duty. And I know you may think that you don’t have anything light duty, but I’m going to encourage you, you really need to find something to do for them that’s from a light duty standpoint, to avoid them getting a lawyer and them coming after you with a lawsuit. In fact, I was meeting with somebody recently and I said, “Hey, what is your plan for returning to work? What is your plan for alternate duty?” And they said, “Well, our plan is they get injured, they get a lawyer and they quit and we settle.” And I started thinking to myself, man, I got to make this video. That’s the reason that I’m making this thing is because of that comment right there.

Now in Georgia, if you have a $2,500 deductible, and we made a video on that as well, anything under that deductible is not going to count against your experience mod. And if you’re wondering what an experience mod is, well, we’ve made a video on that too. But an experience mod, especially if you’re a contractor, is so important because it’s a rating that you’re going to have. And if your rating gets too high, there are certain jobs that you simply cannot get. So now we’re in that mode of we’re trying to preserve your experience mod. So from zero to 2,500, here’s what you should be thinking. Get them back to work and get it closed out as soon as possible, because what we don’t want is for it to go over that $2,500 cap, because then it’s going to start hitting your experience mod.

So then for the next $17,500 of a claim over that, here’s what you need to be thinking. You need to be thinking medical only no lost time, medical only, no lost time. No partial disability. We don’t want any partial disability. And we don’t want any lost time payments to be made because Georgia is also what we call an ERA state and that means that any claim that you’re going to have, that’s medical only, that’s under $17,500 is going to be reduced by 70%. So only 30% of that is going to count against your experience mod. And let me tell you why that is so important.

Number one, your experience mod getting high can prevent you from getting jobs as I mentioned earlier. But because workers’ comp is nothing more than a finance arrangement, it’s nothing more than if you have a claim, it affects mod, it affects your premium and you pay more money. And so whether you realize it or not, all you’re doing is you’re financing those claims. So if you have a $5,000 claim over the course of the next three or four years, that $5,000 claim is going to end up costing you six or $7,000. And so if we can have those medical only reduced, well, what does that mean? It means that that $10,000 claim is only going to end up showing up for $3,000 and instead of costing you 12 or 13, over that time period, it may only cost you three or four over that time period.

So it’s very important that we get them back to work, that we get them going, that they’re not sitting around, that they’re not looking for lawyers and that their claims are being reduced for medical only. I can’t say that enough, medical only, medical only, medical only. That’s what you’re looking for when you go through the claims process. And if it’s a claim that gets over $17,500 and over your deductible, then that’s probably a little bit more serious claim. And so what we want to do at that point is we want to avoid the lawyers. We want to prevent the lawyers from getting involved, because at the end of the day, it’s a really bad deal for the employees because we’re going to pay about two thirds of their salary from loss time and work comp when we get to that point.

And then it’s going to be tax-free to the employee. So they’re going to be getting almost what they were getting before, when they were working full time and we’re going to be rehabbing them, we’re going to be getting them back to work. But what the lawyer’s going to do, they’re going to file some type of lawsuit. It’s going to be a one-time payout. The lawyer’s going to take almost half the money and the employee is not going to have a place to go back to work. And I’ve seen this so many times in my career where we have these employees that say, “Look, I’m so sorry I got the lawyer. I didn’t really realize what was going to happen. My employer got sued. I just thought I needed to get a lawyer. And that was the way that it worked.”

And unfortunately, sometimes it doesn’t really work that well when people go and they get that lawyer. So just be forewarned, that it could be a real problem. And so I know that’s a lot of talking, that’s a lot of strategy that I laid out, but if you want that strategy and you want to talk through it a little bit more with us, we’ll have that alternate duty form that you can download. I would encourage you to use it within your business. And if you don’t have return to work, if you’re not really sure what that is, reach out to me, fill out the calendar link. I would love to talk with you more about return to work and we can lay out what you need to be thinking, step one, two, three, four, all along the way of a work comp claim. So we’d love to hear from you. Let’s talk soon.

Request Your Proposal Here

Are you ready to save time, aggravation, and money? The team at HM Advisors is here and ready to make the process as painless as possible. We look forward to meeting you!

Call Email Claims Payments