What Injuries are Covered by Workers’ Compensation?

When you suffer a job-related injury, understanding what injuries are covered by workers’ compensation is crucial to securing the benefits you deserve. In Georgia, workers’ compensation provides coverage for a wide range of work-related injuries, ensuring employees receive medical care and financial support during their recovery. However, navigating the claims process can be complex, and not all injuries qualify for compensation.

In this blog, we’ll explore the types of injuries covered by workers’ compensation in Georgia, highlight exceptions to coverage, and explain how an experienced Atlanta workers’ compensation lawyer can guide you through the claims process to help secure your benefits.

Types of Injuries Covered by Workers’ Compensation

Workers’ compensation in Georgia covers a broad range of workplace injuries, from common workplace accidents to severe, life-altering conditions, ensuring that employees receive the medical care and financial support they need.

Physical Work-Related Injury on the Job

In Georgia, workers’ compensation covers a wide range of physical injuries that occur in the workplace. This includes emergency medical treatment for immediate care following an incident. These include common incidents such as vehicle accidents, slips, trips, and falls, and injuries from repetitive motion or overexertion. More severe injuries, often associated with hazardous jobs, such as those involving machinery or falling objects, are also covered. However, even desk jobs can lead to injuries that qualify for compensation, such as carpal tunnel syndrome or back issues from improper ergonomics. Whether your injury seems minor or severe, if it occurred during work-related activities, it’s likely covered.

Occupational Illnesses

Workplaces can expose employees to hazardous conditions that lead to occupational illnesses. Workers’ compensation in Georgia covers these illnesses, which can range from respiratory conditions due to toxic chemical exposure, like asbestos or other carcinogens, to long-term illnesses developed over years of exposure to harmful environments. Chronic conditions from chemical exposure or illnesses linked directly to your job duties are also typically covered under Georgia law, providing medical benefits to assist in recovery and return to work.

Pre-existing Conditions

Workers with pre-existing conditions can also receive workers’ compensation benefits if their condition is aggravated or worsened by their job duties. It is crucial to consult a Worker’s Comp. approved physician for medical care in non-emergency situations to ensure that medical bills are covered. For example, if a worker with a back injury experiences a worsening of their condition due to physical labor on the job, they are eligible for compensation until their condition stabilizes. However, compensation is only provided for the period during which the job-related aggravation prevents the worker from returning to their original health state.

Psychological and Emotional Injuries

While workers’ compensation typically does not cover pain and suffering or purely emotional distress, psychological injuries may be covered if they stem from a physical injury or cause physical symptoms, such as migraines or stress-related conditions. For instance, if a worker experiences severe trauma after a workplace accident that leads to emotional distress manifesting in physical symptoms, they may be eligible for workers’ compensation benefits. In these cases, it’s best to consult with a legal professional to determine the eligibility for compensation and to understand the potential financial burden on the healthcare system.

Catastrophic Injuries

Catastrophic injuries are classified as severe injuries that dramatically impact a worker’s ability to function, such as amputations, paralysis, blindness, or severe burns. Injured workers may be entitled to vocational rehabilitation services to assist them in obtaining new employment or learning new job skills, particularly if they have sustained catastrophic injuries. These types of injuries often prevent the worker from returning to their previous job, and they may be entitled to long-term benefits or even permanent disability compensation. Georgia law requires employers to provide specialized medical care for catastrophic injuries, ensuring that injured workers receive appropriate treatment and rehabilitation.

What is Not Covered by Workers’ Compensation?

While workers’ compensation provides broad coverage for job-related injuries, there are specific situations and circumstances where claims, including those for medical bills, may not be covered under Georgia law.

Injuries Resulting from Faulty Actions

Not all injuries that occur in the workplace are covered by workers’ compensation in Georgia. Injuries that happen due to an employee’s faulty actions are generally excluded. For instance, if a worker is under the influence of drugs or alcohol when the injury occurs, or if they fail to follow established safety protocols, their claim may be denied. Additionally, injuries sustained during personal fights unrelated to work or while engaging in horseplay or practical jokes are also not covered. In such cases, workers’ compensation laws do not provide protection, as the injury is considered a result of misconduct rather than work-related duties.

Heart Attacks and Strokes

Heart attacks and strokes are typically not considered work-related injuries under Georgia workers’ compensation laws. These conditions are usually seen as arising from pre-existing health factors, not directly caused by the nature of the job. However, if there is credible medical evidence linking a heart attack or stroke to specific work activities, such as extreme physical exertion or significant workplace stress, it may be possible to file a claim. Without a clear connection between the condition and job duties, workers’ compensation does not cover these health events.

Injuries Outside of Work Hours

Injuries that occur outside of regular working hours are generally not covered by workers’ compensation. This includes injuries sustained during an employee’s commute to and from work, as well as those occurring while on personal breaks or lunch unless the employee is performing a task specifically assigned by their employer. Workers’ compensation coverage typically applies only to injuries that happen during work-related activities or while performing job duties. Injuries unrelated to employment or occurring during personal time falls outside the scope of workers’ compensation benefits.

Legal Steps After a Workplace Injury

After experiencing a workplace injury, taking the correct legal steps is essential to ensure you receive the appropriate medical care, income benefits, and financial compensation under Georgia’s workers’ compensation laws.

Report the Injury Immediately

The first and most critical step after a workplace injury is to report it to your supervisor as soon as possible. Prompt reporting ensures that there is a clear record of the incident and prevents delays in processing your workers’ compensation claim. Injured workers are entitled to receive two-thirds of their average weekly wage, up to a set maximum, which serves as a basis for calculating income benefits when they are unable to work due to job-related injuries. In Georgia, employees are typically required to notify their employer within 30 days of the injury. Failing to do so could result in the denial of your claim.

Document the Scene and Injuries

Thorough documentation of the injury and the surrounding circumstances is essential. Take photographs of the scene, the injury itself, and any other relevant details. If there were witnesses to the incident, obtain their contact information and ask for statements that may support your claim. Clear documentation strengthens your case and provides valuable evidence if your employer or their insurance company disputes your claim.

File a Workers’ Compensation Claim

To officially begin the workers’ compensation process, you need to file a Form WC-14 with the Georgia State Board of Workers’ Compensation (SBWC). This form should also be sent to your employer and their insurance provider. Filing this form is a crucial legal step that formalizes your intent to seek compensation and triggers the investigation and claims process.

Consult with a Workers’ Compensation Attorney

Navigating the complexities of workers’ compensation law can be challenging, especially when disputes arise. Consulting with an experienced workers’ compensation attorney can help ensure that your rights are protected and that you receive the full benefits you’re entitled to under Georgia law. An attorney can guide you through the legal process, assist in gathering evidence, and represent you in any negotiations or hearings with your employer’s insurance company.

Follow Up on Medical Treatment and Benefits

After filing your claim, it’s important to follow through with all recommended medical treatments and document your progress. Physical therapy, as part of a comprehensive rehabilitation strategy, is crucial for treating occupational-related injuries. Keep copies of medical records, receipts, and any communication with healthcare providers. This documentation helps establish the extent of your injury and the medical care required, supporting your case for continued benefits, whether for temporary or permanent disability.

Consult With an Experienced Atlanta Workers’ Comp Attorney Today!

If you’ve been injured on the job and need help navigating the workers’ compensation process, our team at Workers’ Compensation Lawyers Atlanta is here to support you. Let us guide you through every step of your claim, ensuring you get the benefits and care you deserve.

Contact us at 470-518-5026 for a free case review today!