Workers’ Compensation

Workers’ Compensation Benefits

Through workers’ compensation, you can collect a variety of benefits to help you recover from a job-related injury. Our goal as your Augusta workers’ compensation lawyers is to make sure that you get all the benefits owed to you without any stress or complication.

Benefits available through workers’ compensation usually includes:

• Medical treatments: 100% of the medical treatment costs related to your injury that you suffered while working should be covered. Even co-pays, deductibles, and prescription costs should be provided by the insurance company, not you.
• Wage replacement: When you are too injured to return to work for an extended period – such as seven days or longer – you can be eligible for wage replacement or disability benefits. Most injured workers are eligible to receive two-thirds of their average pre-injury wages each week until they can work again or become eligible for permanent disability benefits.
• Vocational retraining: If you cannot return to your previous job position, then workers’ compensation can provide vocational retraining opportunities, such as certifications to complete a new role or even an entirely new career path. For example, an injured construction worker could get retraining to hold gainful employment in an office setting that does not involve manual labor.

Who Is Eligible For Workers’ Compensation In Georgia?

In Georgia, most employers must purchase workers’ compensation insurance if they have three or more employees, including part-time or seasonal workers. For this reason, most people who work in the state do have workers’ compensation coverage or they should. Although, independent contractors are usually not guaranteed workers’ comp from their employers. If you are a contracted worker and not technically an employee, then you might not be covered.

Importantly, workers’ compensation applies to work-related accidents. The location of the accident is not necessarily important as long as you were completing a job-related duty or a task assigned to you by your employer or supervisor. Also, it does not cover non-accidental injuries, such as if you intentionally acted recklessly at work and broke safety protocols when you were hurt.

Filing A Workers’ Compensation Claim In Georgia

Filing a workers’ compensation claim in Georgia involves several steps to ensure that injured employees receive the necessary benefits and medical care after a workplace injury or illness.

Here is a general overview of the process:

• Seek Medical Attention: The first and most important step is to seek medical attention for your work-related injury or illness. It’s crucial to inform your healthcare provider that your injury is work-related and provide details about how it occurred.
• Report the Injury to Your Employer: Notify your employer about the injury as soon as possible. In Georgia, you are required to report the injury within 30 days of the accident or the date you learned of your occupational illness. You should report the injury to your immediate supervisor or HR department, preferably in writing.
• Request a Panel of Physicians: In Georgia, employers are required to provide a list of at least six authorized physicians to injured workers. You must choose a physician from this list for your initial treatment. If you don’t follow this procedure, you may lose your right to receive workers’ compensation benefits.
• Complete a WC-14 Form: You or your employer will need to complete a Form WC-14, which is an application for a hearing to resolve a workers’ compensation claim. This form is used to formally request a hearing if there is a dispute in your case.
• File the Claim with the State Board of Workers’ Compensation: If your claim is not settled with your employer or their insurance company, you may need to file a claim with the Georgia State Board of Workers’ Compensation. This can be done by submitting a completed Form WC-14 to the State Board. The form can be filed electronically or by mail.
• Investigation and Decision: Once your claim is filed, the State Board will investigate your case and make a decision based on the evidence and testimony provided by both parties. This process can take some time, and you may be required to attend hearings or medical examinations.
• Benefits: If your claim is approved, you may be eligible for various benefits, including medical treatment, wage replacement (income benefits), and compensation for permanent disabilities, if applicable.
• Appeals: If your claim is denied, you have the right to appeal the decision. You can request a hearing before an Administrative Law Judge at the State Board to present your case.
• Return to Work: Once you have recovered and are cleared by your physician, you may return to work. Your employer is legally required to offer you suitable employment based on your work restrictions.

Why Was My Workers’ Comp Claim Denied?

Workers’ compensation claims in Georgia can be denied for various reasons. While each case is unique, there are common reasons for claim denials. Understanding these reasons can help injured workers take necessary precautions and improve their chances of a successful claim.

Here are some common reasons for workers’ compensation claim denials in Georgia:

• Failure to Report the Injury on Time: In Georgia, workers are required to report workplace injuries within 30 days of the accident or the date they become aware of their occupational illness. Failing to report the injury within this timeframe may result in a denial of the claim.
• Lack of Medical Evidence: Workers’ compensation claims often require substantial medical evidence to support the injury or illness. If the medical documentation is inadequate or does not establish a clear link between the injury and the workplace, the claim may be denied.
• Discrepancies in the Accident Report: Inconsistencies or discrepancies in accident reports can raise red flags and lead to claim denials. It’s important to provide a clear and consistent account of how the injury occurred.
• Pre-existing Conditions: If the employer or their insurance company can prove that a pre-existing medical condition was the primary cause of the injury or disability, they may deny the claim. However, if the work-related injury aggravated or exacerbated the pre-existing condition, you may still be eligible for benefits.
• Failure to Follow Medical Treatment and Recommendations: Injured workers are typically required to follow prescribed medical treatments and attend medical appointments. If you fail to follow your doctor’s recommendations or refuse medical treatment without a valid reason, your claim may be denied.
• Injuries Outside the Scope of Employment: Workers’ compensation benefits are generally provided for injuries that occur within the scope of employment. If an injury happens while you are not performing job-related tasks or during activities that are unrelated to work, the claim may be denied.
• Lack of Witnesses or Evidence: If there are no witnesses or insufficient evidence to support your claim, it may be challenging to establish the validity of the injury. Documentation, such as accident reports and witness statements, can be crucial.
• Misclassification of Employment Status: Some workers may be classified as independent contractors rather than employees, which can affect their eligibility for workers’ compensation benefits. It’s essential to understand your employment status and whether you should be covered.
• Statute of Limitations: Failing to file a claim within the statute of limitations can lead to a denial. In Georgia, there are specific time limits for filing a claim, so it’s crucial to adhere to them.
• Administrative Errors: Sometimes, claims may be denied due to administrative errors, such as incomplete or inaccurate paperwork. It’s important to ensure that all required forms and documents are properly submitted.

If your workers’ compensation claim is denied in Georgia, you have the right to appeal the decision. Consulting with an experienced workers’ compensation attorney can be beneficial in navigating the appeals process and increasing your chances of receiving the benefits you deserve.

Learn More About Workers’ Comp Today

Want to know more about workers’ compensation and how to get it after a work-related accident? Get trustworthy legal advocates in your corner today by dialing (706) 719-7177. Our Augusta workers’ comp lawyers are always ready to hear from new and returning clients who need legal help now more than ever.

If you prefer, you can fill out an online contact form, too.