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How does the Insurance Company Determine your Weekly Benefit Rate?

This is controlled by the Georgia Workers’ Compensation Statute. First, we need to determine the employee’s average weekly wage. That is, your benefit rate is determined by what your average weekly wage was for this employer. The weekly benefit rate is 2/3 of that average weekly wage up to a maximum of $500.00 per week.

To determine the injured workers’ average weekly wage, we look first to see if he/she worked substantially all of the 13 weeks preceding his/her injury date. Assuming the worker did, the average weekly wage is 1/13 of the total.

If the worker did not work substantially all of the 13 weeks preceding his/her injury date, we look next to whether there is a similarly situated employee who did, and those wages are used.

If neither of the two above methods are applicable, we look to the full time weekly wage of the injured employee. This involves taking the wage per hour multiplied by the number of hours that constitute the full time work week for such an employee, pursuant to the contract of employment with the employer.

As can be imagined, there are many gray areas and different methods of interpretation. Often, a Georgia Workers’ Compensation employee does not work substantially all of the 13 weeks preceding his/her injury date (time off for vacation, lack of work etc.) but the insurance company still uses his wages to determine his/her weekly benefits. This results in a lower weekly check to the injured worker.

Another area for error/different results occurs when the insurance company uses the wages of a “similar employee” who in fact worked fewer hours or earned less per hour; thus resulting in a lower weekly rate for the injured worker.

Further, there is often a dispute regarding what is the full time work week for the employee. We see this often with workers for temporary agencies.

These are areas that an experienced workers’ compensation attorney is needed. Don’t agree on your average weekly wage/temporary total disability rate unless you speak to a Georgia Workers’ Compensation Attorney. You can lose out on significant benefits.

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