If you were injured while at work, you can claim workers’ compensation benefits from your employer in Marietta, Georgia. Your employer is required to have workers’ compensation insurance in order to cover the cost of your medical care and income while you recover from your injury and are unable to work.
However, neither your employer nor their insurance carrier wants to pay workers’ compensation and will look for any reason to dispute your claim and not pay your benefits.
If a dispute arises regarding your workers’ compensation claim, you need to call WCL Atlanta today for assistance in getting the benefits that you deserve.
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Causes Of Workers’ Compensation Disputes
There are many reasons why a dispute may arise regarding your workers’ comp claim.
These may include:
- The status of your employment.
- The injury occurred outside of the scope of your employment. In other words, you were performing a task or activity that was not part of your regular work duties. for example, misconduct, “horseplay” or intentionally harming yourself, or placing yourself in a situation to be harmed in order to claim workers’ compensation.
- The injury did not occur at work. Injuries that were sustained while traveling to and from work, out on a break or off the premises may not be covered by workers’ compensation claims.
- Lack of causation where you cannot prove that your employer was at fault in causing your injury. Your employer and their insurance carrier will investigate the incident.
- You missed the deadline to report your injury within 30 days of your injury.
- You did not provide adequate information regarding the incident that caused your injury, the injury itself or other pertinent information.
There are exceptions to these rules and if your employer or their insurance carrier denies your claim due to any of the above disputes, call WCL Atlanta to find out what to do next.
What To Do If My Workers’ Compensation Claim Is Denied In Georgia?
If either your employer or their insurance carrier refuses to pay your workers’ comp claim, you can request mediation or a hearing from the State Board of Workers’ Compensation (SBWC). You will need to complete and submit form WC-14 to the SBWC within 2 years of the date of your injury.
Mediation is where both sides of the dispute will be heard by an independent 3rd party assigned by the SBWC who will assist in resolving the dispute. A hearing is like a court trial that is overseen by an Administrative Law Judge (ALJ). The ALJ will decide if benefits are due to you and what those benefits are.
If the ALJ denies your workers’ compensation claim or you don’t agree with the benefits that are awarded to you, you can appeal to the Appeals Division of the SBWC. The appeals division will decide whether to uphold the decision made by the ALJ or amend the benefits that you were awarded.
They may also request another hearing from a different ALJ. You have 20 days from the date that the ALJ delivers its decision within which to appeal.
If the decision is still not in your favor, then your can appeal to the Georgia Supreme Court.
It is recommended to contact a lawyer as soon as your claim is denied for advice and to represent your best interests in mediation, a hearing, appeal, or in the Supreme Court. WCL Atlanta is experienced at resolving disputes and provide legal representation throughout the workers’ compensation claims and appeals process.
Types Of Workers’ Compensation Disputes
There are 3 basic types of disputes that can arise from a workers’ compensation claim:
1. Medical Disputes
These may arise as a result of the injury that you sustained. If the injury was considered not to be serious enough to require medical care or time off work, then workers’ comp benefits will be denied. If you did not follow the doctor’s instructions, then you may forfeit your benefits because it appears as if you are delaying your return to work in order to continue receiving workers comp.
2. Income Benefit Disputes
Disputes may arise from whether you are due income benefits and how much. In general, you should receive 1/3 of your wages or salary that you were being paid when the injury occurred. However, if you return to work on light duties you may only receive partial income benefits. You won’t receive income benefits if you do not need time off work to recover from your injury.
3. Claim Disputes
These types of disputes normally arise with regards to not adhering to the claims process or providing insufficient information for the claim to be awarded. For example, if you were treated by a doctor who is not authorized by the insurance carrier and not on the panel of physicians that is provided by your employer, your claim for workers’ compensation may be dismissed.
Missing any of the deadlines to report the injury, request a hearing or appeal your case can also result in the claim being denied.
Resolving Workers’ Compensation Disputes
If any type of dispute arises regarding your workers’ comp claim, then the first step is to try to resolve it with your employer and/or their insurance carrier. In most cases, it is the insurance carrier that will deny the claim and need to be contacted. The insurance carrier is required by law to provide you with a reason for your claim being denied.
It is recommended to contact WCL Atlanta immediately to help clarify the reason for the dispute as well as to attempt to resolve the dispute.
Workers’ compensation disputes are common for two reasons – your employer doesn’t want to submit a claim because it will increase their insurance rates and the insurance carrier wants to avoid paying you benefits. Your employer is also losing because you aren’t able to work while you recover from your injury.
WCL Atlanta is aware of all the tactics that both employers and their insurance carriers use to dispute and deny workers’ compensation claims. Contact us today to help you resolve a dispute and start receiving the benefits that are due to you.
