Securing benefits after a work injury isn’t always easy. If an employer disputes aspects of your claim or denies it all together, you’ll want to make sure your rights are protected. Workers’ Compensation Lawyers Coalition specializes in these and can provide you with the support, guidance, and assistance you need in your Suwanee workers’ compensation dispute.
Table of Contents
Causes of Suwanee Workers’ Compensation Disputes
Your workers’ compensation claim could be denied or devalued for several reasons. Some of the common causes of workers’ compensation disputes in Suwanee, Georgia include:
While all employees are entitled to receive workers’ comp benefits under Georgia law, not all workers are classified as employees. Independent contractors are not eligible to receive these benefits.
However, a worker could be misclassified as an independent contractor if the employer controls the worker’s time or the manner and methods they use to carry out their work. Independent contractors who have been injured should consult with an attorney to see if they may have been misclassified.
Outside Scope of Employment
Work-related injuries typically qualify for workers’ compensation benefits, but in some cases, an employer may argue that an injury occurred outside the scope of employment. Commute injuries, injuries caused by horseplay, and injuries that occurred due to deviations from employment are usually not covered.
Deviations from employment occur when an employee ceases their work duties and carries out something for their personal benefit. Employees may still be eligible to receive benefits if they deviate from work duties, but the injury can not be caused by the deviation.
Lack of Causation
Not all workplace injuries are accidents that occur in front of witnesses. Repetitive occupational injuries are covered under workers’ comp, as can pre-existing injuries that were aggravated by work duties. However, it can be difficult to establish that these injuries were specifically caused by work duties.
If there is not clear, inarguable evidence that a worker was injured on the job, an employer may try to argue that the injury was not caused by work duties at all. It’s important to seek medical attention for injuries early on in order to build evidence that can strengthen your claim.
Georgia requires workers to report injuries within 30 days. If an injury is not reported before that deadline passes, the worker could waive their right to file for benefits. However, even when an employee has missed this deadline, it may be possible for them to file a claim.
In many cases, a worker may have reason to assume that an injury does not need to be reported, like in cases where an injury takes place in front of a supervisor. Employees may also be able to get around missed claim deadlines if an employer failed to communicate the procedure for reporting workplace injuries.
Workers will be asked to provide information about an injury when completing an accident report or filing a claim. If the information provided is not sufficient, the claim could be denied due to a lack of information.
Workers should make sure that all information being recorded is accurate, but should also make a point of being as detailed as possible. If an employee is asked to complete a form when they are on heavy medication or are suffering because of their injury, they should wait. Workers can complete claims at a later time.
What to Do If Your Workers’ Comp Claim Is Denied in Georgia?
The denial of a claim can be a frustrating setback, but it isn’t the end of the line. After a claim is denied, workers can contact the Georgia State Board of Workers’ Compensation and request a hearing. During the hearing, an Administrative Law Judge will listen to both sides before determining if an employee is eligible to receive benefits.
An appeal is far more likely to be successful if it’s properly presented and backed up by strong evidence. Although you can choose to represent yourself in front of a judge, you may struggle to build an effective case, especially if you have a limited understanding of employment law in Georgia.
You’ll be able to present a much stronger argument if you work with an experienced workers’ comp lawyer that has successfully appealed denied claims in the past. An attorney will be able to focus on the impact on your injuries and present a compelling case to the judge on your behalf.
Types of Workers’ Compensation Disputes
Insurance companies won’t always reject a claim entirely. Instead, they may dispute a component of a claim, such as the type of treatment that a worker is receiving for their injury. This is generally referred to as a medical dispute. Workers could be denied surgery, home health services, or other important treatments due to a dispute.
Claim disputes involve other factors, such as disputes over the average weekly wage used to calculate benefits or disputes about the extent of a worker’s injuries. Other examples of claim disputes include disputes over whether a worker has lost income or whether a worker is entitled to certain types of benefits.
It’s very common for disputes to arise after filing a workers’ compensation claim, even when the claim isn’t denied outright. That’s why it’s important to work with a workers’ compensation attorney that can protect your interests and inform you of your rights under Georgia law.
Workers’ Compensation Dispute and Appeals Process in Georgia
It’s possible to resolve a disputed claim via mediation, but a claim can also be appealed and heard by an Administrative Law Judge. Injured workers have one year from the date of the injury to file an appeal.
Once the judge has issued a ruling, both parties will have the opportunity to appeal that ruling. A claim can be heard by the Board of Workers’ Compensation, a superior court judge, and then the court of appeals. In some cases, it may even be possible for an appeal to escalate to the Georgia state supreme court.
Get Help With Your Workers’ Compensation Dispute in Suwanee, Georgia
It can be difficult to navigate a Suwanee workers’ compensation dispute, especially if you’re still recovering from an injury. If you want to make sure you receive the appropriate benefits for your injury, you can depend on the Workers’ Compensation Lawyers Coalition. Call us for a free case assessment at 470-518-5026 .