Employers and insurance companies go to great lengths to dispute workers’ compensation claims. A dispute could mean that they don’t have to pay medical or income benefits to an employee who has been injured at work. However, resolving the dispute can result in a denied claim being paid. There are several ways that workers’ compensation disputes in Winder, Georgia can be resolved.
You should contact the Workers’ Compensation Lawyer Coalition if you have been injured on the job and your employer or their insurance carrier has either raised a dispute or refused to pay your workers’ comp claim. Book a free case evaluation with a Winder workers’ comp lawyer by calling 470-518-5026 or using our online contact form.
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What Are Common Causes of Workers’ Compensation Disputes?
Some common reasons why your employer or the insurance company may deny your claim include the following disputes.
Employment Status
There may be a disagreement regarding if you are a permanent member of staff, or about the wages that you were earning prior to or at the time you were injured. Independent contractors can’t claim workers’ compensation benefits in Georgia.
Outside Scope of Employment
If you were performing tasks or activities that do not fall in the scope of employment or your regular duties, your workers’ compensation can be denied. For example, doing a job that you are not qualified, trained, or required to do or attending an unauthorized gathering at work.
Lack of Causation
In other words, there is no evidence that the injury was sustained at work or as a result of working. Additionally, you may need to prove you weren’t hurt because of your own misconduct. If you were hurt because of horseplay or misconduct in the workplace, your injury will not be covered by workers’ comp.
Missed Deadlines
You have 30 days within which to report a work-related injury to your employer. If you miss this deadline, you may forfeit your benefits.
Inaccurate or Inadequate Information
Your employer needs details about the incident that caused your injury, the injury, and other information in order to determine whether the injury is compensable and if your claim is valid. You must also be honest when pursuing workers’ comp.
Contact our attorneys immediately if your employer or their insurance carrier raises any of the above workers’ compensation disputes in Winder, Georgia.
What Do You Do If Your Workers’ Comp Claim Is Denied in Winder, Georgia?
If your workers’ comp claim has been denied for any reason whatsoever, you need to call a lawyer as soon as possible. Your lawyer will provide you with advice on how to resolve the dispute and get your claim paid. They will also provide you with information and representation if the dispute cannot be resolved or to appeal a denied claim.
Workers’ Compensation Dispute and Appeals Process in Georgia
If you cannot resolve the dispute on your own or with the assistance of a lawyer, your next step is to take your claim to the State Board of Workers’ Compensation (SBWC) in Georgia. You will need to complete and submit a WC-14 form in order for a hearing to be scheduled. The hearing will be conducted by an Administrative Law Judge (ALJ) who will hear all sides of the dispute before deciding whether benefits are due to you and the amount of these benefits.
You also have the option of mediation where the SBWC appointed impartial party will attempt to resolve the dispute between you and your employer/insurance carrier. Although it is not a requirement, it is highly recommended to have a lawyer present at mediation or a hearing.
If mediation fails or you disagree with the decision of the ALJ after your hearing, then you can request an Appellate review from the SBWC. You have 20 days from the decision of the ALJ to appeal to the SBWC who will schedule another hearing or overturn/amend the ALJ decision.
If the appeal is not in your favor, you have one more recourse and that is to appeal to the Supreme Court. You have 20 days from the SBWC appeal decision within which to appeal to the Georgia Supreme Court. You may be required to have a lawyer represent you if you have decided to take the matter all the way to the Supreme Court. It is also in your best interests to have legal representation to improve your chances of getting your claim approved.
Contact the Workers’ Compensation Lawyer Coalition if your claim has been denied to provide you with the necessary support throughout the claims and appeal process to get your workers’ comp claim paid.
Types of Workers’ Compensation Disputes in Winder, Georgia
There are certain circumstances under which your employer or their insurance provider can legally deny workers’ compensation benefits. These types of disputes include:
Medical Disputes
Causes of medical disputes include:
- It is found that your injury was not as serious or extensive as you claimed.
- You did not seek medical care from a doctor on the panel of physicians.
- You did not follow instructions from your doctor to aid your recovery.
- You had a pre-existing health condition that may have caused or contributed to the injury or you failed to disclose a pre-existing health
- condition to your employer or the insurance carrier.
- You intentionally caused harm to yourself or placed yourself in a hazardous position to get injured.
- If your injury was the result of unruly behavior (horseplay) or misconduct in the workplace.
Claim Disputes
Causes of claim disputes include:
- If your injury did not occur while at work or within the scope of performing your work duties.
- If you failed to report your injury within 30 days.
- If there is a dispute regarding the status of your employment or the wages you were earning at the time you were injured.
- If you did not file a claim with the SBWC within one year of sustaining your injury, you will no longer be able to have a hearing or go for mediation.
- If you fail to appeal to the SBWC within 20 days of the decision from an ALJ after a hearing.
- If you fail to appeal to the Supreme Court within 20 days of the decision from your appeal being delivered.
Hire the Best Lawyer for Your Winder Workers’ Compensation Dispute
A dispute with your employer regarding your workers’ compensation benefits can result in your claim being delayed or even denied. Resolving the dispute is a matter of urgency due to the deadlines involved with reporting a claim, filing a claim, and appealing a decision.
To get help with resolving a workers’ compensation dispute and getting the benefits that are owed to you, contact the Workers’ Compensation Lawyer Coalition as soon as possible.
