What Does Catastrophic Mean in a Workers’ Compensation Claim?

The goal of workers' compensation payments is to alleviate the financial strain of being unable to work due to an employment-related injury. Ideally, the injured worker should be able to recover, then return to suitable employment in a timely fashion. But allowances are made for people with injuries designated as catastrophic.

Defining Catastrophic Injuries

A catastrophic injury is the most serious type of workers' compensation claim. As such, there are strict criteria that must be met to qualify for benefits with this designation. The Georgia Workers’ Compensation Act defines this type of claim as one or more of the following:

  • An employee sustained a severe brain or closed head injury.
  • An employee has a spinal cord injury resulting in severe paralysis of the arm, leg, or trunk.
  • The injury resulted in the amputation of an arm, a hand, a foot, or a leg.
  • The injury resulted in second or third degree burns covering more than 25 percent of the body or third degree burns covering 5 percent or more of the worker's face or hands.
  • The worker has a diagnosis of industrial or total blindness.
  • The employee's injuries render him unable to perform his prior work, as well as any additional work available for which he is otherwise qualified.

The last classification—"unable to perform his prior work, as well as any additional work available"—results in the most litigation due to the subjective nature of the statement. It is easy to determine if someone has had a limb amputated or lost their eyesight, but evaluating if someone is unable to work is more difficult.

Some of the factors to be considered include:

  • Past work experience
  • Education level
  • Feasibility of additional job training
  • Vocational analysis
  • Types of opportunities available in the current job market
  • Whether the worker qualifies for Social Security disability benefits

Removing the Time Limits for Benefits

In the majority of cases, workers' compensation benefits have a strict time limit of availability:

Workers who are most seriously injured are considered to have catastrophic injuries. Georgia law allows these individuals lifetime medical treatment and indemnity (weekly income) benefits in addition to appropriate rehabilitation benefits.

Eligibility for Rehabilitation Services

In addition to eliminating the cap on medical assistance and weekly income benefits on catastrophic injury claims, this designation also allows injured employees to receive rehabilitation services. What this involves will vary depending upon the type of injury and the worker's past employment history, but could include:

  • Career counseling
  • Analysis of transferable skills
  • Vocational evaluations
  • Resume writing
  • Interview coaching
  • Working with potential employers regarding job accommodations and modifications
  • Receiving tuition assistance for retraining
  • Miscellaneous job placement services

An employee with a catastrophic injury receives these services at no additional cost, and is required by law to utilize any rehabilitation benefits that are deemed appropriate to his case.

Meeting the Burden of Proof

When determining whether a worker's injury should be classified as catastrophic, the burden of proof rests with the employee and his attorney. Therefore, having access to skilled legal representation is essential to the success of your case. Due to the high cost associated with catastrophic claims, workers' compensation insurers will do everything possible to avoid this designation. Please contact the legal team at Rechtman & Spevak for a free, no-obligation case review.