Georgia’s workers’ compensation benefits are intended to flow fluidly and quickly assuming all legal criteria are met. Unfortunately, there are many instances where it does not occur in this ideal matter.
A dispute can arise at various points in the program ranging from the initial claim to the coverage of specific medical treatments. But just because a dispute occurs does not mean you should relinquish your rights to receive workers’ comp benefits. It is entirely possible to mediate and solve disputes in a way that allows you to continue receiving benefits.
If you are involved in a workers’ compensation dispute, then we strongly advise seeking legal counsel. Our Mableton workers’ comp attorneys can negotiate and mediate on your behalf to resolve disputes and ensure that you receive the proper amount of compensation.
It’s up to you to reach out and seek legal assistance. Do this by contacting us at 470-518-5026 and we will provide a free case review.
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Causes of Workers’ Compensation Disputes in Mableton
Some common causes of workers’ compensation disputes include:
1. Employment Status
An employer may attempt to dispute a claim based on the employment status of the injured worker. This is most common in industries that employ contract workers. Independent contractors are considered self-employed and are thus generally ineligible to receive workers’ compensation benefits.
However, the situation is not always so straightforward and there are some cases where non-traditional employees are entitled to benefits. The courts can determine whether a particular relationship is considered an employee-employer relationship based on several factors, including the way your payments are received, the amount of time you have worked with the employer, who is in control of your work hours and materials, and the nature of the work contract.
2. Outside Scope Of Employment
Georgia statute states that an injury must “arise out of and in the course of employment”. You must have been performing duties within your normal scope of employment for the injury to meet these criteria. If you suffered from an injury while taking a break or while commuting to work, then it will very likely be disputed by your employer or the insurance provider.
3. Lack Of Causation
Your employer may ask your attending physician to write a causation letter. This is a medical report that will explain the cause of the illness or the injury suffered. If it is determined that the causation is not related to your work environment or duties, then the claim may be denied. It may be argued that the causation was actually a pre-existing medical condition or a repetitive stress injury that involved actions taken outside of work.
4. Missed Deadline
This is one of the most frequent causes of a workers’ compensation dispute. An injured worker has only 30 days to report their injury to their employer or a supervisor. They also have only one year to file a workers’ compensation claim. The longer you wait to report an injury or file a claim the greater the risk of denial. It is in your best interest to report your injury immediately and begin filing the claim as soon as possible.
5. Inadequate Information
An employer may attempt to dispute a claim based on a lack of information regarding the accident. A common example is when there are no witnesses to the accident. Being injured while working alone is not an acceptable reason to dispute a benefits claim. Workers’ compensation attorneys can help you gather the sufficient evidence and information required to appeal and receive benefits.
What to Do If Your Workers’ Comp Claim is Denied in Georgia?
Here are the steps you should take if your workers’ compensation claim is denied.
Request Hearing Before The State Board Of Workers’ Compensation
The next step after denial is beginning the appeals process. You do this by filing the WC-14 form with the Georgia State Board of Workers’ Compensation. You have a deadline of one year to file this claim, but we do not advise waiting this long. Filing as soon as possible will make it easier to gather the necessary evidence and prepare your case. The appeals process can last for several months so the sooner you get it started the sooner you can begin receiving benefits.
Contact an Attorney
Once you have decided to appeal we advise contacting a workers’ compensation attorney. Having a professional legal team on your side will make it much easier to navigate the tricky legal waters. They can assist with mediation, negotiations, pre-trial hearings, and in the courtroom. There is no reason to move forward without professional legal assistance if you want to overturn your denial.
Types of Workers’ Compensation Disputes
Medical Disputes
These disputes only affect the medical benefits made available. The insurance provider may dispute a specific medical treatment, the use of a specific doctor, or the involvement of a secondary injury. Medical disputes do not involve a denial of the benefits as a whole.
Claim Dispute
This happens when the employer or insurance provider attempts to deny the claim as a whole. They may argue that the injury occurred outside of the workplace or did not involve your scope of employment duties. A claim denial will prevent access to medical, disability, and death benefits.
Workers’ Compensation Dispute and Appeals Process in Georgia
The first hearing will be scheduled within 60 days of filing your WC-14 form. It will take place before an Administrative Law Judge (ALJ) is selected by the Georgia Board of Workers’ Compensation. The ALJ does not have the ability to award a settlement for a workers’ compensation claim. They only have the power to rule on compensability and ensure that benefits are received.
You also have the right to appeal the decision made by the ALJ by filing an appeal with the Appellate Division. They may overturn the judge’s decision, make an amendment to the decision, or reaffirm the decision that was made. You will have 20 days from the ruling of the ALJ to file an appeal.
Contact Our Mableton Workers’ Comp Attorneys Today
There are several reasons why an employer may deny a workers’ compensation claim, but you have the right to appeal that denial. The appeals process can be lengthy and involve numerous legal hearings. We suggest immediately contacting a workers’ compensation attorney when you decide to begin the appeals process.
Call our local office in Mableton at 470-518-5026 if you are ready to appeal your denied claim.
