Unless you work in construction, mining, or similar high-risk industry, the workplace is not a place you would expect to get harmed or injured. However, most people fail to realize that workplace accidents, leading to severe injuries and diseases from exposure to chemicals and other substances are common in almost every industry. That is why Georgia law requires all employers with at least three employees to purchase workers’ compensation insurance.
Georgia’s Workers Compensation Act is a system meant to provide financial support to workers who sustain an injury or fall ill while on the job. Unfortunately, there are cases where the employer and insurance providers deny a workers’ claim or offer an unfair settlement amount.
Sustaining an injury while at work can be stressful as it usually means dealing with medical bills, and not working for an extended period. As you may have guessed, the situation will only get worse if your workers’ comp claim is denied or disputed.
If your claim has been denied or disputed for whatever reasons, you have the option to appeal the fight for your rights. In order to increase your chances of success, it is advisable to have a lawyer with experience handling workers’ compensation disputes in Dublin by your side. We have helped numerous employees fight workers’ comp disputes.
Our Dublin workers’ compensation lawyers will provide you with the best legal route for your dispute and aggressively fight for your rights. So, call us today at 470-518-5026 for a free, no-obligation initial consultation.
What Are Common Causes of Workers’ Compensation Disputes?
There are numerous reasons why your workers’ comp claim might be denied. Knowing why can help determine not only the best way forward, but also if you had a valid claim, to begin with. If your claim has been denied, you will get a ”Denial of Claim” letter from your employer or insurance provider, detailing why it was denied. That being said, here are some of the reasons your boss or the insurance carrier can use to deny your workers’ comp claim.
1. Employment Status
This is perhaps the most important factor when it comes to determining the validity of your claim. You can only qualify for workers’ compensation benefits if you are currently employed. This means that if you were fired, laid off, or quit before making a claim, then you are not eligible for workers’ comp benefits.
This is meant to prevent those who wish to take revenge on their former employers after losing their job. Insurance companies will almost always deny a claim made by a worker after losing their job.
2. Outside Scope of Employment
For your claim to be considered valid, the injury should have occurred while performing your duties at work. If the injury happened outside the scope of your employment, both your boss and insurance carrier have legal grounds to deny your workers’ comp claim.
3. Lack of Causation
There needs to be an inherent connection between your injuries and your work in order for the claim to be considered compensable. This implies proving that the injuries or the illness was contracted during the course of your duties.
4. You are Not a Qualified Employee
Some workers do not qualify for workers’ comp benefits. These include farm workers, undocumented workers, independent contractors, domestic workers, and seasonal workers.
5. Missed Deadlines
There is a legal deadline for filing a workers’ compensation claim. This is known as the statute of limitations and in Georgia, it is one year from the date of the accident. Also, you need to formally notify your employer about the accident and resulting injuries within 30 days of the incident.
6. Inadequate Information
For your claim to be considered valid, you need to provide as much information as possible to both your employer and insurance provider about the injury or illness and how it occurred. Lack of adequate information and witnesses are some of the reasons claims get denied.
What to Do If Your Workers’ Compensation Claim Is Denied in Georgia?
First and foremost, you need a clear reason why your claim was denied. The next step is to file an appeal. Begin by requesting a hearing before the State Board of Workers’ Compensation. Here, an administrative judge will listen to your case and determine whether or not, you qualify for benefits. This hearing usually takes place within 60 days after submitting Form WC-14.
Although it’s not a requirement, it is advisable to have a lawyer by your side. An experienced legal representative will make the process less stressful by handling the case on your behalf. Ensure you file your appeal within a year from the date of the accident to avoid missing out on your settlement.
Types of Workers’ Compensation Disputes in Dublin, GA
There are two types of workers’ compensation disputes that arise in a workers’ comp claim:
1. Medical Disputes
These come up when your employer or insurance provider denies the claim on medical grounds. For instance, they may argue that you sustained the injury before the supposed accident, your illness was as a result of other factors, had an underlying condition, etc.
2. Claim Disputes
These come up when your employer or insurance provider denies the claim on grounds of failure to follow the rules stated in Georgia’s workers’ compensation act. For example, they may claim that you didn’t file the claim within the set deadline or the injury happened when under the influence, did not happen within the scope of your employment, etc.
Hire a Lawyer for Workers’ Compensation Disputes in Dublin!
When you sustain an injury or fall ill while on the job, you are entitled to workers’ compensation benefits. If your employer or their insurance company denies your claim, ensure you follow through with an appeal to protect your rights. At the Workers’ Comp Lawyer Coalition, we are ready to help you with the legal process after a claim denial.
Reach out by calling 470-518-5026 and we can get started. The Workers’ Compensation Lawyers Coalition team will offer the best legal advice and fight aggressively to ensure your case is handled in a fair manner.