Injuries sustained at work are often covered by workers’ compensation insurance. Many states require firms to carry insurance that reflects the typical amount of risk in their sector. You still have choices, though, if your workers’ compensation claim is rejected. You might be able to challenge the decision before the Georgia State Board for Workers’ Compensation. Filing a claim can be difficult and appealing a denied claim is even more complex.
If you or a loved one sustain an injury at work, seek medical attention immediately, and then contact an experienced workers’ compensation attorney. The claim process can be difficult and the Conyers workers’ compensation lawyer at Joel Thrift Law will know how to handle your claim through the entire process, including an appeal.
How Can a Workers’ Comp Attorney Assist You?
Many workers are not aware of their rights or do not fully comprehend them after suffering a work-related injury. Employers are required to make sure they have access to all pertinent documentation and provide details on workers’ compensation claims. This isn’t always the case, and a worker requesting workers’ compensation might not be aware that they have not been given all the information they require. A workers’ compensation attorney can be useful in this situation.
A workers’ compensation attorney can also help with the hearing and appeal process if a claim has already been denied. It is possible that many people are unaware that they have three years from the day their claim was rejected to reopen it.
After an injury related to the job, dealing with employers and the claim procedure can be frightening. A workers’ compensation lawyer can help immediately after a workplace injury. An experienced workers’ compensation lawyer can help with sending notice to your employer and making sure they complete the needed report on time in order to prevent a claim that has expired or is banned.
What is a Workers’ Compensation Claim
Workers’ compensation provides benefits to employees who have sustained work-related injuries or who have become ill, disabled, or disabled due to their employment. Most firms require workers’ compensation insurance.
The laws governing workers’ compensation vary from state to state and can be quite complicated. You can learn more about your fundamental rights under the Georgia’s workers’ compensation system and your employer’s responsibilities by hiring an experienced workers’ compensation attorney.
The only way to receive benefits after a workplace injury is to file a claim and follow the entire claim process. There are various benefits that can be received, depending on the injury. Each state has a different approach to workers’ compensation, and it is important to know your rights and the claim process.
Common Injuries for a Workers’ Comp Claim
If you are on the job and acquired in injury, it will likely be covered in a workers’ compensation claim. Any injury (physical and mental) that is suffered at work during work duties, will be covered if your employer has the proper insurance. If they do not have the proper insurance, then that leaves them open for a lawsuit and you still have the opportunity to recover.
There are injuries and accidents that are more likely to occur. The most common types of injuries seen by the state of Georgia for workers’ compensation claims are:
- Injuries sustained in a motor vehicle accident (largely truck accidents)
- Overexertion injuries from repetitive movements (even in a desk job)
- Slip and fall accidents, whether on an uneven surface, in a stairwell, or from a spilled substance
- Industrial accidents where heavy machinery is frequently used
- Crush injuries from falling objects
- Construction injuries
The risk of significant workplace injuries is generally higher for more hazardous jobs. However, any form of job, even desk work, puts you at risk for injury. Don’t assume that just because you don’t have a “dangerous” employment that your injury isn’t covered.
Contact a knowledgeable Georgia workplace injury attorney to discuss your case if you have questions regarding your work injury or are concerned that your employer won’t pay for it. They can ensure that you are aware of your rights and how to receive the benefits you are entitled to.
When is an Injury Note Covered by Workers’ Compensation Insurance?
Most injuries are going to be covered as long as they are: (1) at work and (2) performing duties related to the job. However, there are some instances (rare) that will likely not be covered if you try to file a claim:
- When a worker was using a substance such as alcohol, marijuana, or drugs and sustained an injury.
- If the worker was not following the safety procedures and outwardly doing something that put them and other workers at risk.
- Physical injuries sustained from a fight with another co-worker or visitor.
- Not using the proper safety equipment and protection guides
- Purposefully injuring yourself and trying to make false claims.
When a person makes false claims, they are subject to penalty and even jail time under Georgia code. Georgia is a no-fault state, which means that it is not necessary who caused the accident to receive workers’ compensation benefits. However, if there are signs of horseplay or other behavior that was not work related, that would be grounds for a denied claim. A worker can be the cause of their own injury and still receive benefits if it was a true accident and they were performing the task as assigned.
Employer Duties After a Workplace Injury
As a business owner and employer, it is your duty to establish a safe working environment for all of your employees, including both traditional office workers and telecommuters (those who work from home) under the guidelines provided by OSHA. The following responsibilities of the business apply when an employee suffers an injury while performing tasks related to their job:
- Call for Medical Assistance: Determining the level of emergency following an accident is the first stage after a workplace injury. If the injured person needs emergency medical assistance, call 911. You might be able to call a medical advice hotline through your workers’ compensation insurance if your injury is small but needs medical attention to find out whether urgent care or the emergency room is the best course of action.
- Reporting the Injury: You should report the injury as soon as you can to your workers’ compensation insurance provider. The sooner you get in touch with the claims adjuster, the less likely it is that you will miss something and be in non-compliance with the workers’ compensation regulations.
When an employee suffers an injury at work, they file a claim with the insurance provider (or self-insuring employer), who subsequently pays medical and disability benefits in accordance with a state-approved formula. Unless they fall under certain exempt categories, employers who do not have workers’ compensation insurance are subject to fines, criminal charges, and civil liabilities.
Employee Rights After a Workplace Injury
The most crucial and straightforward way to protect legal rights as an employee is to report accidents to an employer. The majority of states mandate that an injured worker disclose their accident within a certain time frame after it occurs, typically the same day or within a few days (Georgia requires 30 days). Depending on the specifics of the event, this might not always be possible, but it is imperative to report the injury as soon as you can.
The initial step in defending one’s legal rights is filing a claim for workers’ compensation with the State Board of Workers’ Compensation. This is used to formally notify an employer, the court, and the employer’s insurance company about the injuries.
The laws governing workers’ compensation vary widely from state to state. Both the legal processes used to defend an injured employee’s rights and the rights themselves differ greatly. Although not all states recognize all legal rights, the following are generally accepted by most (including Georgia):
- the ability to file a lawsuit against a corporation, its insurance provider, or workers in general.
- the choice of bringing a lawsuit for an injury or illness in the state industrial court or the workers’ compensation court.
- the right to return to a job if an injury or illness prevents you from doing so permanently or temporarily.
- the right to some form of disability benefits in the event that the injured worker disagrees with a judgment rendered by the workers’ compensation court, the employer, or the employer’s insurance provider.
- the right to visit a physician and receive treatment if a doctor approves the worker’s return to work.
Understanding your right to do something as an employee is just as important as knowing your right to say no to requests or offers. In the event that you are injured on the job and your employer advises you to utilize your own health insurance to cover your medical expenses rather than applying for workers’ compensation benefits, you have the right to be represented by an attorney throughout the entire process.
Georgia Workers’ Compensation Requirements
According to the Georgia State Board of Workers’ Compensation (SBWC), each company in Georgia with three or more regular employees is obliged by law to obtain a workers’ compensation policy for its employees. This indicates that your employment probably qualifies you for workers’ compensation coverage.
Workers’ compensation claims in Georgia operate under a “no-fault” basis, in contrast to personal injury claims, where payment is based on negligence. Whether you caused your work injury or not is irrelevant. You have the legal right to make a claim if the damage occurred while you were at work, and it should be covered regardless of fault.
What if a Workers’ Comp Claim is Denied in Georgia?
Keep pursuing benefits even if your workers’ compensation claim was initially denied. Examine the letter alerting you that your claim has been rejected very carefully first. It will undoubtedly mention the reasons why it was rejected. Contact the claims adjuster to see if you can address the problem if you think it was brought on by inaccurate documentation or anything similar. This route is unlikely to be successful, though, unless your employer or the insurance provider made a genuine mistake and acknowledged it. You’ll probably need to think about appealing the rejection.
Of course, some workers’ compensation applications are rightfully denied. Employees will not be entitled for benefits if they fabricate or substantially exaggerate their illnesses. The right to receive workers’ compensation payments may also be properly denied to employees who were intoxicated at the time of the accident and injuries.
Fighting a Denied Workers’ Compensation Claim
Once you are aware of your denied claim, you may decide to appeal the judgment. The refusal letter must provide a deadline for submitting an appeal, as required by state law. You have 20 days from the date you receive the refusal letter to file an appeal in Georgia. However, you should first consult with your employer (or its insurance provider) to determine if the issue can be resolved without the involvement of the workers’ compensation commission. It can just be a simple misunderstanding or a typing error that is straightforward to fix.
If you choose to challenge the ruling, bear in mind that doing so requires insight from a workers’ compensation lawyer because it is a challenging legal procedure. State-by-state variations exist in the appeals procedure, but in Georgia, it often comprises a hearing before an administrative law judge, which can be arranged through the labor department or Georgia’s workers’ compensation board. You may have a choice of where to submit your appeal and there may be numerous levels of appeal.
Any documentation that discusses the reason(s) for the denial, including medical data, shall be forbidden. This may consist of the findings of a subsequent medical exam, a timesheet demonstrating that you were employed at the time of the injury, or any other supporting documentation. However, be sure you are aware of the processes if you plan to appeal. Unlike a court, the workers’ compensation commissioner’s office follows different rules.
Hiring a Conyers Workers’ Compensation Lawyer
Imagine the relief of having a top workers’ compensation lawyer in Conyers, Georgia fighting for you rather than attempting to gain proper compensation for your workplace injury on your own. A workplace injury is always a stressful matter, contact Joel Thrift law today to help alleviate the burden of handling a claim by yourself. We will be there for you from day one and until you have received full compensation for your injury. You can schedule a free consultation by giving us a call or completing the online form.