Getting injured while on the job is not only frustrating but can also leave you with a huge financial burden. Workplace injuries will often call for medical treatment and may also keep you out of work, meaning that you may lose a portion of your earnings. However, workers’ compensation ensures that you are covered and that you receive medical and indemnity benefits if you suffer a work-related injury.
Under workers’ compensation laws, there are various criteria that have to be met for you to be awarded workers’ compensation benefits. Basically, your injury has to be work-related and must occur in the course of your employment if you’re to receive workers’ compensation benefits. If your injury doesn’t tick these boxes, your employer will dispute your claim and you may lose your workers’ compensation benefits.
If your claim is denied or disputed for whatever reason, it is important that you seek legal assistance. At the Workers’ Compensation Lawyers Coalition, our attorneys understand Georgia’s workers’ comp laws and can guide you and help you receive benefits after your claim is denied. Get in touch with us today by filling our online form or calling via 470-518-5026 to speak to one of our workers’ compensation lawyers about your Fayetteville workers’ compensation dispute.
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Causes of Fayetteville Workers’ Compensation Disputes
While workers’ compensation makes it easy for employees who suffer workplace injuries to receive benefits, claims are not always straightforward. Workers’ comp claims may be disputed by your employer or their insurance carriers on various grounds. Some of the most common causes of disputes in workers’ comp claims include:
Under Georgia law, your employment status must be covered by workers’ comp laws for you to receive benefits for a work-related injury. Essentially, this insurance system covers employees of companies and businesses with 3 or more workers, whether on full-time or part-time basis.
Georgia’s workers’ compensation law doesn’t cover some employees, and such workers may not be eligible for benefits in the event of a work-related injury. Such employees include U.S. government agencies workers, longshoremen, railroad employees, independent contractors, volunteers, and some farm laborers.
Outside Scope of Employment
Basically, you are only entitled to workers’ compensation benefits if your injury was as a result of work activities or duties and occurred in the course of employment. Otherwise, you may not receive benefits even if you were injured at your workplace.
It is possible to sustain a non-compensable injury at your workplace. Such injuries are considered to be outside the scope of employment, and include:
- Idiopathic or spontaneous injuries
- Injuries arising from assault or on-the-job fights
- Off-work aggravation of pre-existing conditions
- Injuries arising from after-work activities
- Injuries sustained during lunch and rest breaks (there are some exceptions to these)
- Injuries sustained to or from work, unless you were on call, at your employer’s parking lot, or running a beneficial errand for your employer while leaving or going to work.
- Injuries arising from practical jokes
- Injuries resulting from willful misconduct.
Lack of Causation
Your employer may dispute your claim if the injury you claim is not directly related to your employment. In such a case, your employer cites a lack of causation, and you may lose your benefits. For you to receive workers’ compensation benefits, your injury must have been directly caused by your work or your employer’s instructions.
The validity of workers’ comp claims in Georgia will also depend on certain time limits. In the event of a work-related accident, you are required to report your injury to your employer immediately, but not later than 30 days from the date of the accident. Appeals for denied or disputed claims are also time-dependent as you are required to file Form WC-14 within 1 year of your work-related injury.
Providing adequate information about your injury when reporting to your employer may help prevent the denial of your claim. With clear information, you eliminate any doubts that your employer could have and leave them with almost no reason to deny your claim.
When reporting your workplace injury, it is important that you indicate the date, time, and location of the injury, provide photos of your injury (if visible) and provide the name of any co-worker who witnessed the accident that caused your injury.
What To do if Your Workers’ Comp Claim is Denied in Georgia
If your workers’ comp claim has been denied by your employer or their insurance carrier, you can request a hearing before the Industrial Commission of Georgia by filing Form WC-14. This has to be done not later than 1 year from the date of your workplace injury if your request for a hearing is to be considered.
Contacting an attorney is also a good way of protecting your right to receive workers’ comp benefits in the event of denial of your claim. A workers’ comp lawyer will guide you through the process of filing your claim and most importantly ensure that you do it within the allowable time.
Types of Workers’ Compensation Disputes
The denial of your workers’ compensation claim may be as a result of various disputes, but the main ones are the following:
These are disputes that arise whenever your employer has questions regarding the opinion or medical facts regarding the treatment of your injury. Medical disputes majorly entail questions regarding surgery, physical therapy, home health care, prescription medicine, and medical equipment.
These are also referred to as indemnity disputes and often include issues regarding the calculation of average weekly wages, disability, compensability, the extent of injury, and the right to Supplemental Income Benefits (SIBs).
Workers’ Compensation Dispute and Appeals Process in Georgia
If your workers’ comp claim has been denied, or aren’t satisfied with the benefits awarded by your employer’s insurer, you have a right to request a hearing before Georgia’s Workers’ Compensation Board and appeal the decision. This is done by filing Form WC-14 within 1 year from the date of your workplace accident.
During the hearing, an Administrative Law Judge will listen to your case and decide whether you deserve workers’ comp benefits and the amount based on the facts presented by your attorney.
Find the Right Lawyers for Fayetteville Workers’ Compensation Disputes
Workers’ compensation is a form of insurance that provides benefits to employees who are injured while on the job. In most cases, these claims will be straightforward, as long as your injury is compensable and happened out of and in the course of employment.
However, employers may cite various reasons to dispute your claim and deny you workers’ compensation benefits. Whenever this happens, you need an experienced lawyer to guide you on the appeal process to ensure that you receive your much-deserved benefits.
If your Fayetteville workers’ compensation claim is denied or disputed by your employer, get in touch with the Workers’ Compensation Lawyers Coalition in Fayetteville via 470-518-5026 to start the appeal process with one of our Fayetteville workers’ compensation attorneys.