According to federal and state laws, when an employee suffers an injury while on the job, they deserve compensation benefits to cover medical expenses, lost income, rehabilitation costs, and other benefits. However, getting these benefits is not as easy as it sounds. Valid workers’ compensation claims are often improperly investigated, undervalued, and unfairly denied in bad faith or due to human error.
If insurance denies your workers’ compensation claim, you are dissatisfied with your claim’s evaluation, or you face other mishaps, you can dispute your case with the workers’ compensation board, the insurance carrier, or before a judge. But, if you want to maximize the chances for a favorable outcome, you should involve a Watkinsville workers’ compensation attorney.
Watkinsville workers’ compensation disputes can prove to be frustrating, especially without a lawyer. Having a lawyer spearheading your claim can prove beneficial since they will bring loads of experience and knowledge. At the Workers’ Compensation Lawyers Coalition, our attorneys can help you solve your workers’ compensation dispute and fight aggressively for the benefits you deserve. Call us at 770-796-0919 to get help for your medical or claim disputes.
What Are the Most Common Causes of Workers’ Compensation Disputes?
Watkinsville workers’ compensation disputes arise from various scenarios. Your employer or their insurance company can dispute your workplace injuries in the following situations:
In Georgia, only individuals classified as workers are eligible for workers’ compensation benefits. Independent contractors do not qualify for workers’ compensation because they do not fall in the category of workers. Sometimes employers intentionally misclassify workers as independent contractors to avoid paying premiums. Workers’ compensation disputes may arise from misclassifying a worker’s employment status.
Outside Scope of Employment
The scope of employment refers to activities that have to do with and originate from the work, trade, business, or profession of the employer and that are performed by a worker while furthering the affairs of the employer’s business. Workers’ compensation covers injuries that happen in the scope of employment.
A dispute may arise when your employer or insurance carrier argues that your injuries occurred outside the scope of work. I.e., your workplace injuries or accident did not result from the conditions or activities at the workplace.
Lack of Causation
For your workers’ compensation claim to be valid, there must be a cause and effect relationship between your injury or illness and a condition or activity in the workplace. Your boss or their insurance provider may dispute your claim, citing no connection between your on-the-job injury and the conditions or activities at work.
During the workers’ claim process, employees must meet specific deadlines or risk invalidating their claims. For instance, before filing a claim, an employee should report their injury to their manager or employer. In Georgia, the deadline for reporting a workplace injury is 30 days.
Likewise, there is also a deadline for filing a workers’ compensation claim set at one or two years, depending on the situation. When an employee fails to respect these deadlines, their employer or insurer can dispute their claim for workers’ compensation benefits.
When an employee files a workers’ comp claim, investigators will first determine the validity of their claim before they can award any compensation. For this reason, the employee has to provide all the necessary information, including medical records and payroll history. Your claim can be disputed if investigators discover that you have provided inadequate information.
What to Do If Your Workers’ Comp Claim Is Denied in Watkinsville, GA
There is no reason to panic when insurance denies your workers’ compensation claim. This happens all the time. You have 20 days after the denial to file an appeal and request a hearing before the industrial commission. Contact an attorney to help you through the appeal process.
Types of Workers’ Compensation Disputes
There are two main types of workers’ compensation disputes in Watkinsville, Georga. Both medical and claim disputes prevent an injured employee from getting benefits that they may be eligible to receive.
This type of dispute relates to the injured employee’s treatment, so it is a matter of medical fact and opinion. Medical disputes may include: denied surgery, denied therapy, denied assisted living services, and denied medical supplies such as braces and other devices. If you are battling a medical dispute, an experienced workers’ comp attorney can help you understand your options.
These types of disputes involve issues that a lawyer can help with. They include matters to do with compensability, disability, the extent of injury disputes, average weekly wage disputes, among many others.
Workers’ Compensation Dispute and Appeals Process in Georgia
If you can’t resolve a dispute with your employer or the insurer directly, the disagreement will escalate, and you will have to rely on alternative dispute resolution options. The resolution options will depend on the jurisdiction, the insurer, and other facts. The appeals process involves:
You may first be asked to mediate with the insurance provider and your employer to negotiate a favorable settlement agreement for both sides. A neutral third party will help the involved parties to resolve their workers’ compensation dispute to avoid having to proceed to litigation.
If you fail to resolve your claim during mediation, your case will move on to a formal hearing. These hearings typically occur in courtrooms located in the county where the injury happened and are conducted by the state workers’ compensation board. Your lawyer will make legal arguments and present evidence before a judge. The judge must deliver a verdict within 30 days.
If you are still not satisfied and wish to appeal the decision after the hearing, your lawyer can apply for a review within 20 days of the hearing verdict to take the case to the appellate division of the State Workers’ Compensation Board. The appellate will evaluate written arguments from both sides and then make a decision.
Finally, if the judge and the SBWC rule against you, you can appeal further and proceed to the Georgia Court of Appeals. You’ll want to have an experienced workers’ compensation lawyer on your side.
We’re Experts at Handling Watkinsville Workers’ Compensation Disputes
Workers’ compensation disputes can prevent you from getting your hands on benefits you are entitled to and deserve. An attorney from the Workers’ Compensation Lawyers Coalition in Watkinsville can help you understand and resolve a workers’ comp dispute. Call 770-796-0919 to begin discussions with our attorneys. We offer a free initial consultation service, and you only pay us if and when we win your case!