Individuals who are employed in companies with three or more employees may have the right to medical and indemnity benefits whenever they suffer work-related injuries. Such employees may also have the right to disability benefits if they are deemed to have suffered an impairment even after reaching maximum medical improvement.
Under workers’ compensation, an injured worker may be entitled to benefits regardless even if they are at fault for the workplace accident. In exchange for this, they are expected to give up their right to file a personal injury lawsuit against their employer in a bid to recover damages.
While the workers’ comp claim process may seem easy and straightforward, workers’ compensation disputes in Villa Rica may arise leading to a drawn-out process. It is advisable to speak to a lawyer before beginning your claim process, and especially when disputes arise. If you have been injured on your job and your employer has disputed your claim, reach out to the Workers’ Compensation Lawyers Coalition to schedule a free consultation with one of our Villa Rica workers’ compensation lawyers.
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Causes of Workers’ Compensation Disputes in Villa Rica
In most cases, employers won’t accept a workers’ compensation claim forthright. Like other types of insurance policies, business or company owners have to pay premiums to ensure injured employees receive workers’ comp benefits. As such, many employers are quick to dispute workers’ comp claims for their own financial benefits. Below are some of the reasons your workers’ comp claim may be disputed by your employer.
Employment Status
Claim disputes are often a result of the arrangement under which one is engaged to work for an employer. In Georgia, employers with 3 or more full-time or part-time employees are supposed to carry workers’ compensation insurance. If you’re employed in such an organization and get injured while on the job, then you may be in line to receive workers’ compensation benefits.
However, some employees are not entitled to workers’ comp benefits in Georgia. Employees who fall under the following categories will most likely have their claim disputed under workers’ compensation:
- Independent contractors
- Railroad workers
- Federal employees
- Longshoremen
- Farm laborers
Despite these provisions, it is always advisable to speak to a workers’ comp attorney near you to find out whether you’re eligible for workers’ compensation benefits.
Outside Scope of Employment
Under workers’ compensation, you can only receive benefits if you get injured while doing what you’re reasonably expected to do as part of your job. It follows that if you get hurt while engaging in other activities, other than those you’re expected to do as part of your job, your employer will most likely dispute your claim. Some injuries that may be deemed “outside the scope of employment” include those caused by the following activities:
- Willful wrongdoing or total disregard of safety guidelines
- Workplace fights
- Horseplay
- Injuries that occur during lunch or rest breaks
- Injuries occurring on your way to or from work.
Lack of Causation
In order to be eligible for workers comp benefits, your injury must have been directly caused by your work and in the course of your employment. Otherwise, your claim could be disputed for lack of causation. In order to receive workers’ comp benefits, you must show that your injury was a result of a work-related accident and nothing else.
Missed Deadline
In Georgia, there are various time limits that govern workers’ comp claims. If you’ve suffered a work-related injury, you are required to report to your employer or supervisor not later than 30 days from the date of the injury. Further, you’re required to file a notice of claim not later than 1 year from the date of the accident. Failure to meet any of these deadlines might lead to the loss or forfeiture of your workers’ compensation benefits.
Inadequate Information
An injury report after a workplace accident should provide as much information as possible and be devoid of ambiguity. This makes it easier for your employer to look into your injury, meaning that the award of your benefits will be expedited.
What to Do if Your Workers’ Comp Claim Is Denied in Georgia
If your employer or their insurance carrier denies your claim for whatever reason, the most sensible thing to do is take legal action. Georgia law provides that you have the right to request a hearing before the State Board of Workers’ Compensation.
To ensure that you get everything right, it is advisable that you contact an experienced Villa Rica attorney to guide you through the process. In Georgia, you must request a hearing within 1 year from the date of the workplace accident.
Types of Workers’ Compensation Disputes
Workers’ compensation disputes in Villa Rica, GA may arise due to various reasons, but will mainly be categorized into medical and claim disputes.
Medical Disputes
Generally, these are issues that relate to the medical aspect of the workplace injury or the treatment of the same. These disputes could involve the denial of proper medical treatment, including surgery, physical therapy, or the relevant medical equipment. Medical disputes could also arise if you are injured and refuse to seek reasonable medical care.
Claim Disputes
These are disputes that arise from legal issues that relate to workers’ compensation claims, and attorneys can prove helpful with such disputes. Such claims may involve the following issues:
- Compensability of your injury or occupational illness
- Disability, rating, and whether you’re eligible for income benefits
- Extent of your workplace injury
- Calculation of average weekly wage disputes
- Eligibility for supplemental income benefits.
Workers’ Compensation Dispute and Appeals Process in Georgia
In Georgia, workers who have had their workers’ comp claims disputed or denied have the right to appeal. This is done by filing the WC-14 form to request for a hearing before the State Board of Workers’ Compensation. If your request is granted, you are given a date to appear before an administrative law judge.
During the hearing, the judge listens to your case and evidence as presented by witnesses. Your employer’s insurance company or their defense team will also present their pieces of evidence. After listening to both sides, the judge will make a decision on whether you will receive benefits or not.
Hire a Skilled Lawyer for Your Villa Rica Workers’ Compensation Dispute
Suffering a work-related injury can be stressful, but it can be even more devastating to have your claim disputed by your employer. If you feel that your workers’ compensation claim was disputed or denied unfairly, you have the right to request a hearing before the State Board of Workers’ Compensation. Call the Workers’ Compensation Lawyers Coalition at 470-518-5026 or fill our online form today to schedule a consultation to find out your rights under workers’ compensation.
