Besides taking time off work, workers who sustain on-the-job injuries are left with a significant financial burden due to medical treatment and other costs. Under workers’ compensation laws, such workers are entitled to receive various benefits if their injuries are compensable and their employer carries workers’ compensation insurance.
Workers’ compensation is an insurance system that is meant to compensate employees who get injured while on the job for medical expenses and lost income, and protect employers from lawsuits that may arise after workplace injuries. However, workers’ comp claims may not always be straightforward as workers’ compensation disputes in Jeffersonville, GA may arise.
If you have been injured while on the clock and your claim has been denied by your employer or their insurance carrier, don’t hesitate to seek legal help. Call our skilled team of Jeffersonville workers’ compensation lawyers at 470-518-5026 for a free consultation.
Table of Contents
Causes of Workers’ Compensation Disputes in Jeffersonville, GA
Your employer may dispute your claim due to various reasons, with the most common being:
Georgia law makes it mandatory for business and company owners who employ 3 or more workers, on a full-time or part-time basis, to carry workers’ compensation. It is also important to note that workers’ comp coverage begins the first day of your employment.
In Georgia, there are various classes of employees that aren’t covered under workers’ compensation. Some of these include:
- Federal employees
- Independent contractors
- Farm laborers, unless an employer carries workers’ comp and notifies the State Board of Workers’ Compensation
- Railroad workers
If your claim is denied but you don’t fall under any of these employment classes, it is important that you speak to a lawyer to find out the validity of your claim.
Outside Scope of Employment
To receive workers’ comp benefits, your workplace injury has to meet certain criteria: the injury must arise out of and in the course of your work. If your injury doesn’t meet these conditions, it may be deemed non-compensable and you may not receive workers’ compensation benefits.
Some injuries that are considered to be outside the scope of employment include:
- Injuries arising from an employee’s willful misconduct or deliberate disregard of safety rules and guidelines at their workplace
- Injuries that result from workplace fights or assaults
- Spontaneous or idiopathic injuries
- Lunch or rest break injuries. However, an exception to this is when you are injured when doing a beneficial activity for your employer, under their order
- Horseplay injuries and those arising from practical jokes
- Injuries resulting from off-employment aggravation of pre-existing conditions
- Injuries suffered to and from work. Exceptions to this include injuries suffered at the parking lot, or if you were injured while running an important errand for your employer on your way to or from work
Lack of Causation
To receive workers’ compensation benefits, there must be proof of legal causation. You must show that your injury arose from your employment and nothing else. If there is no direct connection between our injury and employment, your claim may be denied for lack of causation.
Reporting your workplace injury immediately or in a timely manner is crucial to the validity of your claim. In Georgia, you are required to notify your employer within 30 days of your injury.
If your claim is denied or disputed and wish to appeal, you have 1 year to request a hearing from the Industrial Commission. If you miss these deadlines, you may lose your right to receive workers’ comp benefits.
The validity of your workers’ comp claim also depends on how much information about your injury you provide when reporting. It is important that you clearly note the date of the workplace injury, where it happened, and the name of a co-worker who was present at the time of the accident that resulted in your injury. If your injury is visible, it is also important that you provide clear photos of the same.
What to Do if Your Workers’ Comp Claim is Denied in Georgia
It is not uncommon for workers’ compensation claims to be denied, as employers or their insurance carriers may cite various reasons. In the event of denial of claim, it is important that you appeal for a chance to receive the benefits you deserve. You can file Form WC-14 with the Workers’ Compensation Board of Georgia to request a hearing before an Administrative Law Judge.
If you intend to appeal the dispute or denial of your claim, it is important that you don’t go through the process alone. Having a workers’ comp lawyer throughout this process is vital, as your employer’s insurance carrier will have a legal team to represent them during the hearing.
Types of Workers’ Compensation Disputes
Your claim may be disputed by your employer or their insurer for various reasons. The most common disputes that arise in workers’ compensation claims are:
These disputes involve questions regarding the medical facts around your injury. They may arise if you got medical treatment from a physician who wasn’t recommended to you by your employer. These disputes may also arise if you refuse to accept reasonable medical treatment, including surgery, therapy, in-home care, or refuse to use the recommended medical equipment.
Also referred to as indemnity disputes, these often arise due to legal issues regarding your claim. Claim disputes will generally arise due to questions over the compensability and extent of your injury, disability, determination of your average weekly wages, and qualification for Supplemental Income Benefits.
Workers’ Compensation Dispute and Appeals Process in Georgia
Appealing the denied or disputed workers’ comp claim involves requesting a hearing before an Administrative Law Judge. This should be done by filing Form WC-14 not later than 1 year from the date of the injury. If a hearing is granted, the Judge will hear your case and make a decision on whether you will receive benefits or not.
Hire a Lawyer for Your Jeffersonville Workers’ Compensation Dispute
The award of workers’ compensation benefits after reporting a work-related injury isn’t always straightforward. Sometimes, your employer or their insurance carrier may dispute the validity of your claim and deny your benefits. If you feel that the reasons for disputing your claim aren’t justified, you should speak to a workers’ comp lawyer immediately.