Getting injured at work may mean that you have additional medical expenses and no income while you recover, and here it starts the workers’ comp claims process. For most of us, this can be a serious financial setback. However, under Georgia law, you have the right to claim medical and income benefits from your employer after a workplace injury. This is called workers’ compensation.
But this doesn’t mean that your employer or their insurance provider will be happy to pay your claim. The fact is that they will do everything in their power to deny your claim. Understanding the workers’ compensation claims process and the recourse that you have available to you if your claim is denied is crucial.
WCL Atlanta are experienced workers’ compensation lawyers and are here to provide you with help you need to get the benefits you deserve.
How Do I Know If My Injury Is Covered By A Workers’ Comp Claims Process?
An injury that is covered by workers’ compensation is called a compensable injury. This type of injury must fulfill the following requirements:
– Your injury must have been sustained in the workplace. Injuries that happened while travelling to and from work, while out on your lunch break or off the work premises will not be covered.
– Your injury must have been sustained within the scope of your regular work. If you were fulfilling a task that you aren’t trained or qualified to perform or you were doing something you weren’t supposed to do at work, then your injury may not be covered.
– Your injury may not result from misconduct or “horseplay” in the workplace.
– If you were injured while attending an unauthorized gathering at work, your injury is not compensable.
– If you had a pre-existing health condition that resulted in the injury, then you won’t receive benefits. For example, if you had a heart attack at work and have a history of heart disease.
– The injury resulted from self-harm. If you intentionally hurt yourself or put yourself in a dangerous position so that you can claim workers’ comp, you will not receive benefits.
How Long Do I Have To File A Workers’ Compensation Claim In McDonough, Georgia?
You have 30 days from the date of your injury to report your injury to your employer. However, it is recommended to report your injury immediately or as soon as possible. If you miss the deadline, you will forfeit your benefits.
If your claim has been denied, you have 2 years from the date of your injury to appeal your claim with the State Board of Workers’ Compensation (SBWC).
It is advisable to contact a WCL Atlanta before or as soon as possible after reporting your injury to avoid your claim being denied. If your claim has already been denied, we can assist you with the appeals process.
How Do I File A Workers’ Comp Claim In Georgia?
The workers’ compensation process begins with you, the employee, reporting the injury to your employer. Your employer then has 7 days within which to inform their insurance carrier of your injury. The insurance company will investigate, decide whether your injury is compensable and then either award benefits or deny your claim.
If your claim is denied or you don’t start receiving your income benefits within 2 weeks, you can file your claim with the State Board of Workers’ Compensation in Georgia. In order to do this, you need to complete and submit form WC-14 to the SBWC within 2 years of the date of your injury.
You can get this form from the State Board of Workers’ Compensation.
The SBWC will schedule a hearing before an Administrative Law Judge (ALJ) who will hear both sides of the claim and then decide what benefits you should receive – if any. If the ALJ does not award any benefits or you disagree with the benefits that are awarded, you can present your claim to the Appeals Division of the SBWC. You have just 20 days from the date that the ALJ delivered his or her decision to appeal.
If you miss this deadline, you will have no further recourse to get your workers’ compensation awarded.
The Appeals Division can overturn or amend the decision. They may also schedule another hearing before a different ALJ. If the decision is once again not in your favor, then you have one last recourse and that is to appeal to the Georgia Supreme Court. You have 20 days from the date of the decision from the Appeals Division to file your case with the Clerk of the Supreme Court.
If you miss the deadline to appeal to the Supreme Court, you will have no further means to get your workers’ compensation approved.
It is highly recommended to get legal advice before reporting your injury to your employer or as soon as possible afterwards. This will help you establish whether your claim is compensable and what steps your employer or their insurance carrier may take to avoid paying your claim.
It is even more critical to have a legal representation if your claim has been denied. Sometimes, just having a lawyer is sufficient to get a denied claim overturned by the insurance carrier without ever having to appeal your case. Your lawyer will also attempt to resolve the dispute regarding the payment of your workers’ comp claim with your employer and/or their insurance carrier.
If you do have to appeal to the State Board of Workers’ Compensation, you have the right to be represented at the hearing. A hearing is similar to a court trial and having a lawyer can improve your chances of having the decision overturned.
Should you decide to take your claim to the Supreme Court, you will need to have a lawyer represent you. It is important to understand that the Supreme Court will not overturn or amend a decision by the State Board of Workers’ Compensation unless it can be proved that the decision was fraudulent, that it was made without weighing all the evidence or there is another legal reason to deny your claim.
To help you get through the complicated workers’ compensation claims process, contact WCL Atlanta today.