In the unfortunate event that you are injured as a result of a Lilburn workplace accident or suffer an occupational illness, you are entitled to workers’ compensation benefits under Georgia law. However, employers and their insurance companies aren’t always comfortable paying out these benefits and may try to outrightly deny your claim or try to minimize the amount that they have to pay.
At the Workers’ Compensation Lawyers Atlanta, we believe in justice and we believe that you deserve every penny legally owed to you. Our capable team of Lilburn workers’ compensation lawyers will help protect your rights and ensure that your Lilburn workers’ compensation dispute is resolved in your favor.
Call us today at 470-518-5026 for a free case review and learn more about what your best options are.
Table of Contents
What Are Common Causes of Lilburn Workers’ Compensation Disputes?
Your employer or their insurance company may deny your workers’ compensation claim due to a number of reasons which include, but are not limited to:
Your Employment Status
Under Georgia’s workers’ compensation act, you can only recover benefits if your claim is filed while you are an employee of the company. An employee could be a part-time or full-time worker, a minor working for the company, or an alien (legally or illegally hired).
Keep in mind that independent contractors aren’t covered under workers’ compensation. In their defense, your employer may try to argue that you worked as an independent contractor when you were injured.
In addition, the claim has to be filed while you are still an employee of the company. This means that if you sustained injuries then quit or were fired from your job before you filed the claim, the claim is deemed invalid.
Outside Scope of Employment
For you to have a valid claim your injury must have occurred while you were doing a work-related activity or an activity that was for the benefit of your employer. If your employer is able to prove that your injuries didn’t happen within or out of the scope of your employment, you won’t be entitled to receive workers’ compensation benefits.
Keep in mind that an injury that happens during lunch break or while traveling to and from work (apart from when attending to business errands) isn’t covered under workers’ compensation.
Lack of Causation
Your employer may also deny your claim by arguing that there is no causal connection between your job and your injury. Your employer can argue that your injuries didn’t happen while you were in the course of performing your duties or as a result of any unsafe condition in your job environment.
Missed Deadlines
When it comes to filing Georgia’s workers’ compensation claims, there are certain deadlines that need to be met at different stages to ensure a valid claim. To begin with, you are required to notify your employer (preferably in writing) of the injury as soon as possible or within 30 days of the incident. If your supervisor witnessed the accident as it happened, this also counts.
Next, you have one year from the date of the accident to file a notice of the claim with the State Board of Workers’ Compensation. In case your employer has already provided medical treatment, you have one year from the date of the last treatment to file the workers’ compensation claim.
If your employer has provided indemnity benefits, then you have two years from the date of the last payments to file a workers’ compensation claim in Georgia.
It is important to keep all these deadlines in mind as failure to meet either can deem your claim invalid. This can give your employer or their insurance company legal grounds to deny your claim. This is why it is important to get in touch with an experienced attorney as soon as possible after the accident who will ensure that all procedures are followed and according to the set deadlines.
Lack of Enough Information
When filing a workers’ compensation claim, you need to ensure that you provide the insurance company with as much information as possible regarding the incident and your injuries. This is highly important as the insurance company can deny your claim due to enough evidence to substantiate your claims.
The lack of witnesses to support your claims is another common reason why workers’ compensation claims are denied.
An attorney will help ensure that you have all the relevant facts and evidence to support your claims.
If the insurance company denies your claim, you will get a “Denial of Claim” letter explaining why your claim was denied. Understanding why your claim has been denied will help you and your attorney determine the best course of action.
What Should I Do If My Workers’ Compensation Claim Is Denied in Georgia?
The fact that your claim has been denied doesn’t necessarily mean that you are ineligible to receive workers’ compensation benefits. You still have the option to appeal the denial and fight for your right to compensation.
Workers’ Compensation Dispute and Appeals Process in Georgia
After having your claim denied, you need to find out exactly why it was denied and file an appeal. The appeal process is initiated when you request a hearing before the State Board of Workers’ Compensation who will have a judge hear your case and determine whether you should be awarded workers’ compensation benefits.
An appeal is filed through the WC-14 form, which is also the form used to file a workers’ compensation claim with the State Board of Workers’ Compensation. The hearing is usually scheduled within 60 days of filing the WC-14 form.
Keep in mind that you need to file the appeal within one year of the accident, otherwise you completely lose your right to pursue compensation benefits.
Hiring an attorney will help make the entire process less stressful and overwhelming and will also ensure that you don’t make any errors that may jeopardize your claim. An attorney will help you gather all the relevant evidence to ensure that you have a solid claim. With an attorney on your side, you are guaranteed the best outcome in your claims and appeal process.
Types of Workers’ Compensation Disputes
There are two main categories of workers’ compensation disputes based on the grounds used to dispute an injured employee’s claim:
Medical Disputes
These are disputes that occur when an employer or their insurance company denies a claim based on medical grounds, for example, they may argue that an employee’s injuries aren’t as serious as the employee claims to be or that the injury was caused by other factors and not something work-related or that the injury already existed before the said incident.
Claims Disputes
These are disputes that occur when a claim is denied based on the claimant’s failure to adhere to the rules and procedures involved in Georgia’s workers’ compensation claims, for example, failing to file paperwork within set deadlines.
Get Help Today With Your Lilburn Workers’ Compensation Dispute
Suffering a workplace injury is devastating in itself, however, having your claim unjustly denied makes your problems all the more unbearable. You need an attorney who has experience with Lilburn workers’ compensation cases who will help you deal with your case and guarantee the best outcome.
Contact our skilled attorneys at the Workers’ Compensation Lawyers Atlanta for the best legal representation. Just call 470-518-5026 or use our contact form to schedule your free consultation.
