You’re entitled to benefits if you’ve suffered a work injury, but claiming those benefits may not be easy. Workers’ compensation disputes in Monroe can keep you from accessing treatment and financial benefits.
Thankfully, if you’re in this situation, the Workers’ Compensation Lawyers Coalition can work with you to resolve this dispute so that you can receive all of your benefits. Schedule a free consultation with one of our Monroe workers’ compensation lawyers today.
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Causes of Workers’ Compensation Disputes in Monroe
Insurance companies often look for reasons to turn down a workers’ compensation claim. Because employees are legally entitled to receive benefits for a compensable injury, however, insurers must have a valid reason for their denial. Some of the most common reasons claims are disputed or denied include:
Employment Status
To qualify for workers’ compensation in Georgia, an individual must be an employee or a statutory employee. While part-time workers and newly hired workers have coverage, independent workers are not entitled to benefits.
With that said, independent contractors may still be eligible to claim workers’ comp. Many workers are misclassified as an independent contractor when they should legally be an employee. Not only is a worker that has been wrongly classified as an independent contractor entitled to workers’ comp, but they may also be eligible to receive back pay for wage violations.
Outside the Scope of Employment
Illnesses or injuries that occur in the course of employment are covered. However, an insurer may argue that an injury occurred outside the scope of employment and should not be covered. This type of dispute could occur if a worker deviated from their job duties, engaged in horseplay, or was intoxicated at the time of the injury.
A claim could also be disputed if the injury did not take place in the workplace. Injuries that take place during a commute are not considered to be work injuries and are not covered by workers’ comp. Work from home injuries and injuries that occurred at company-sponsored events should still be compensable.
Lack of Causation
In order to receive benefits, an illness or injury must have been caused by a workplace accident or a work-related tasks. While causation is easy to establish in many cases, it can be difficult to prove that an injury is work-related in other cases, especially when the injury developed over a period of time.
Seeing a physician early on is one of the best ways to establish causation. When an injury is overseen by a medical professional, it can create evidence that will make it difficult to dispute a claim on these grounds.
Missed Deadline
Georgia’s statute of limitations gives workers one year from the date of injury to file a claim for benefits. However, in order to preserve the right to workers’ compensation, workers must report their injury to their employer as soon as possible.
If a work injury is not reported within 30 days, a claim could be denied due to missed deadline. For injuries that develop over time, employees must report the injury within 30 days of being informed of the injury by a doctor.
What to Do If Your Workers’ Comp Claim Is Denied in Georgia
If your workers’ comp claim has been denied, you don’t have to give up on collecting benefits. If you believe that the claim was wrongfully denied, you can request to have your case heard by the State Board of Workers’ Compensation. To request an appeal, a completed WC-14 form must be submitted to the board within one year of the date of injury.
After the form has been submitted, a hearing will typically be scheduled within 60 days. During the hearing, both parties will have the opportunity to present their side in front of an Administrative Law Judge. The judge will make a decision based on the facts and the evidence presented during this hearing, which is why it’s crucial to contact an experienced workers’ comp attorney that will be able to handle your appeal for you.
Georgia doesn’t require workers to be represented by a lawyer during their denial hearing, but working with an attorney can significantly improve your chances of a successful appeal. While you do have the option of appealing the Administrative Law Judge’s decision, your chances of a successful appeal will grow smaller each time your claim is denied.
Types of Workers’ Compensation Disputes
Workers’ compensation disputes in Monroe typically fall into one of two categories.
Medical Disputes
Medical disputes occur when an insurer disagrees about the necessity of medical treatment or services. These disputes can make it more difficult for injured workers to get the care they need in order to properly recover. During a dispute, an insurer may refuse to pay benefits.
The State Board of Workers’ Compensation should be contacted in cases involving medical disputes. The board may recommend mediation so that the dispute can be resolved. If an experience attorney represents you during the mediation process, you have a better chance of resolving the dispute so that you can get the treatment and benefits you’re owed.
Claim Disputes
Claim disputes take place when the claim itself is disputed by the employer. As an example, an employer may argue that the claim is not compensable, or that you have not provided proof of your injuries or evidence that shows liability. An attorney can help you to take care of any issues so that you can resolve your dispute and collect your benefits.
Workers’ Compensation Dispute and Appeals Process in Georgia
There are two different categories of workers’ comp claim denial. A claim could be denied as a whole, or certain aspects of the claim could be denied. In either case, workers’ have the right to appeal this decision if it is keeping them from collecting benefits they are entitled to.
The first stage of appeal is to have your case heard before an administrative law judge. That decision can be appealed to the Board of Workers’ Compensation, then to a superior court judge, and then to the Court of Appeals. While it is possible for claims to be heard by the Georgia Supreme Court, workers’ comp disputes do not have federal jurisdiction and cannot be heard by the United States Supreme Court.
Contact Our Monroe Workers’ Comp Attorneys Today
Workers’ compensation law is complex, and successfully appealing a denied workers’ compensation claim in Monroe is difficult without the help of a lawyer. Thankfully, Workers’ Compensation Lawyers Coalition specializes in these cases and can help you resolve this dispute. If you’d like a free case evaluation, call us at 470-518-5026 today.
