An unexpected accident at work can be traumatic and worrying. Fortunately, most workers are covered by their employers’ workers’ compensation insurance which should compensate them after a genuine workplace accident or illness for medical expenses and lost earnings. Not all claims are honored by the insurer, however, and it may take an appeal with the state’s workers’ compensation body before compensation is awarded. A workers’ comp. attorney can be of real help if an appeal is necessary. Workers Compensation Law in Georgia Most employers in Georgia, with some important exceptions, must take out workers’ compensation insurance with a commercial carrier. The State Board of Workers’ Compensation is the state agency that oversees workers’ compensation and deals with disputes between employees and insurers in the event of a claim denial. If you do have an injury at work, or become sick as a result of you job, you should make sure you notify your employer within 30 days of the accident or sickness developing. Late notifications are often the cause of a claim denial. Your actual claim should be made within a year of the accident. A successful claim should pay all medical costs as well as two thirds of any lost wages. Usually these benefits only start from the second week unless the disability lasts for more than three weeks. Your employer may determine who treats you. Reasons for a Workers' Comp Claim Denial in Georgia Common reasons for a workers’ compensation denial by an insurance company include: failure to notify the employer within time limits imposed or failure to make a claim within the specified time limit; administrative errors in dates at work leading to false assumption that worker was not at work when injury took place. Insurance companies may also allege more serious reasons for a denial. These may not be true but may be difficult to refute without evidence and/or witnesses. For example, a denial may be made if it has been alleged that: you were intoxicated at the time of the incident; your injuries were made outside of work or before you said they were; you deliberately caused your own injuries in order to obtain compensation; you failed to use available safety equipment or failed t follow established procedures even though you were aware of them; your claim was for a mental illness or a heart complaint. The Georgia Workers' Comp Appeals Process If your claim is denied by the insurer you should appeal the decision by submitting a request for a hearing with the State Board of Workers’ Compensation. A hearing will be set aside in which you can present any evidence that supports your claim. A representative from the insurance company or their attorney will also be present. Mediation, which is more informal, may be attempted before a hearing to see if an amicable agreement can be made between you and the insurer. It is important that if you do go to a hearing that you realize it is like a trial. Witnesses must turn up in person and you should be thoroughly prepared. If you still disagree with the judge’s decision after a hearing you may still be able to appeal further by taking the complaint to the Appellate Division of the State Board of Workers’ Compensation. Why an Attorney is Advisable After a Workers' Comp Claim Denial If your claim is denied and you want to appeal the decision it is strongly advised that you seek legal help. A workers’ comp. attorney can help you prepare for a hearing and represent you during what can be a complex and confusing process.
