Many workers have injuries or other medical conditions which are not initially covered by the employer/insurer under the Georgia Workers Compensation Act.  You may be told by a supervisor or someone in human resources – or even by an insurance adjuster employed by the workers’ compensation carrier – that your injury or medical condition is not covered.  As an injured worker, you must prove that you sustained an accidental injury within the scope and course of your employment.  Sometimes, a workers compensation attorney is needed to assist in providing the necessary proof to insure that the claim is accepted and benefits are timely provided.

In many instances, the injury is not in dispute – but not all injuries are the result of a specific incident at work.  Your condition could be due to a cumulative trauma resulting from years of performing your work duties.  A cumulative trauma may qualify as an accidental injury thus entitling you to benefits under the Georgia Workers Compensation Act.

Sometimes, employers/insurers deny the existence of an employment relationship or they claim the injury did not arise out of your employment.  Your claim may be denied despite the fact you are an employee and you were injured at work.  At other times, employers/insurers argue that an injury is pre-existing and not directly related to your work activities.  With sufficient proof, the State Board of Workers’ Compensation will find that an aggravation of a pre-existing condition caused by your work duties is an accidental injury, which entitles you to benefits under the Workers’ Compensation Act.

Many employers/insurers require an injured worker to submit to post-injury drug and alcohol testing.  While a positive post-accident drug or alcohol test may provide grounds for a defense of the claim, a positive test is not an absolute defense.  An experienced attorney can assist you in obtaining benefits by challenging the timing and method of testing and the final test results.  So, it is important for you to understand that a positive post-accident drug or alcohol test does not always prohibit you from obtaining workers’ compensation benefits for your injury.

If you believe your medical condition is the result of an accidental injury, you must notify your employer within 30 days of the injury. Once notice of injury is provided, it is the responsibility of the employer/insurer to offer employer-funded medical treatment, including transportation to and from doctors’ appointments.

As an injured worker, you have additional rights regarding ongoing medical treatment. For example, you may have the right to an employer-funded independent medical evaluation with a doctor of your choice. You may also have the right to change doctors if you become dissatisfied with your initial treating physician.

In addition to providing medical benefits, there are three types of income benefits designated for injuries:

• Temporary total disability
  This is for workers who are totally disabled, but expected to recover enough to return to work in the future. You receive a weekly check paid for each week you cannot work due to your injury. The amount you receive is based on 2/3 of your average weekly wage (AWW). The AWW is computed by averaging your gross wages for the 13 weeks prior to the injury. The maximum you can receive in temporary total disability benefits is $725 per week.
• Temporary partial disability
  This is for workers who are partially disabled, but are able to return to work with restrictions, but at a reduced AWW. You receive 2/3 of the difference between your AWW when injured and your AWW upon your return to work. The maximum amount an injured worker can receive for temporary partial disability is $483 per week.
• Permanent partial disability
  A permanent injury can result in permanent partial disability, meaning a person permanently loses the use or function of part of the body. This loss limits the person to certain types of work, which may have a lower salary than his or her previous job. The amount you receive is based on the permanent partial disability rating issued by your treating physician.

An employer/insurer has a twenty-one day grace period from the date of the injury to investigate the accident before either providing benefits or filing a denial of your claim. Unfortunately, it is common for claims to be ignored by the employer/insurer even though you provided timely notice of when you were hurt on the job. The employer/insurer might provide only limited medical treatment or no treatment at all. Despite missing time from work because of your injury, the employer/insurer may refuse to send weekly income benefit checks. Other times, without explanation, the employer/insurer might deny the claim outright.

If this occurs, you must file a formal claim with the State Board of Workers’ Compensation in order to protect your rights. You have one year from the date of injury in which to file the formal claim with the State Board. The one year statute of limitation can be extended if the employer/insurer provided medical treatment, but the form must be filed with the State Board within one year of your last receipt of employer-funded medical treatment. However, it is very important to understand that if no income benefits are paid nor medical benefits provided, your claim will be forever barred if the formal notice is not filed in a timely manner.

In some claims, medical and income benefits are initially provided, but are then suspended based upon a return to work, an offer of suitable employment, or a full-duty release from the treating physician. If you believe your benefits have been wrongly suspended, the only way to protect your rights is to file a formal claim with the State Board. Once the claim is filed, you will then have the right to present evidence to an administrative law judge seeking an order for the recommencement of your benefits. The Trial Division of the State Board of Workers’ Compensation sets hearings before administrative law judges in the county or contingent county where the injury occurred. Hearings are typically held 60 to 90 days after the notice is filed.

After the hearing with the administrative law judge, there is a four step appeals process. Within 20 days of the administrative law judge’s award, either side can file an appeal to the Appellate Division of the State Board. This process usually takes two to three months. The State Board will either affirm or reverse the administrative law judge’s finding. The next level of appeal is to the Superior Court in the county where the injury occurred. Attorneys for each side will present arguments. The Superior Court is legally bound to affirm the State Board’s award if there is no legal error or if there is any evidence supporting the findings. After that, either side may take the claim to the Georgia Court of Appeals, but they must apply to be heard.

This is why we strongly urge you to contact us if you have been hurt on the job – we’ll walk you through the process and answer all of your questions. It can be a confusing process, but with our 30+ years of workers compensation experience, we’ve helped many workers hurt on the job get everything they deserve.

The Workers’ Compensation Act is a complex series of laws and rules. The insurance companies have attorneys on staff to help the employers and claims adjusters deal with the intricacies of the laws. Sometimes, claims are denied due to a lack of investigation, because employers do not quickly notify the insurer that you have been injured. Other times, claims adjusters fail to notify injured workers of their full rights after a work injury. In these instances, the claim is either denied outright, or the injured worker does not receive their full benefits.

An experienced workers compensation attorney can explain the laws which impact your claim and simplify the process to increase your chances of collecting the full benefits due to you. If your work injury claim has been denied, or if you are not presently receiving the type and amount of benefits due to you, an attorney experienced in the representation of injured workers can protect your rights by filing a claim on your behalf with the State Board of Workers’ Compensation.

Remember, the purpose of the Workers’ Compensation Act is to compensate employees who suffer a work injury. Claims adjusters work for insurance companies – not for you. Employers, in many instances, are less concerned about you and your work injury. Instead, they are more concerned whether your injury is going to increase their workers’ compensation premiums.

If you have questions or concerns about how your claim is being handled or whether you are receiving your full benefits, please call your work injury lawyers at 706/868-1090 or contact us online.