Expert answers to some of the most common questions about Workers’ Compensation in Georgia. Practical advice on claim denials, process for filing claims, what injuries are covered, and more.
What to Know
If you are injured at work in Georgia, it is your responsibility to report the injury as soon as possible. Even if you are not sure whether you need medical care, you should report your injury to your employer.
What to Do
Report your injury in writing and keep a copy for yourself. If your employer does not have an injury report form, you can simply describe your injury on a piece of paper. It’s important to take this step even if you are unsure whether the pain or injury will require medical attention.
What to Know
The answer to this question depends on whether your claim has actually been denied or whether the employer simply never reported the claim to their workers’ comp insurance carrier. You’ll need to insist on a clear answer.
What to Do
First, clarify whether your employer filed a claim with their insurance carrier. If your employer did not file a claim, insist that they do. If they refuse, get help from an attorney who specializes in Georgia workers’ comp law. If the insurer reviewed and denied your claim, it’s time to talk to a workers’ comp attorney.
What to Know
Yes. And employers in Georgia sometimes do fire employees after they file a workers’ comp claim. This is legal in Georgia. But being fired does not affect your ability to win your claim. In fact, it often helps.
What to Do
Ask for an official separation notice stating in clear terms the reason you were fired. Even though being fired is stressful, keep in mind that it could help with your claim.
What to Know
The basic deadline for filing a Workers’ Comp claim in Georgia is one year from the date of the injury. However, this deadline may be extended based on what the employer or insurance company does with your claim.
The law on this is complicated. If the employer or insurer has paid for medical treatment or issued a weekly check, the deadline is extended. Don’t assume it is too late to file a claim until you’ve talked directly with a workers’ comp lawyer about your situation.
What to Do
Don’t just assume it’s too late to file workers’ comp because the insurer or your employer told you that. You should talk with a worker’s comp lawyer to get an accurate answer about whether your claim is time barred.
What to Know
The short answer- it’s more complicated than you would think. If you have a physical injury that is related to your job, you may have a workers’ comp claim– even if you didn’t have a specific accident. Your injury can come from a specific accident (like falling off a ladder) or the gradual stress your job puts on your body (like a back injury from doing heavy lifting at work every day).
In Georgia, you may also be covered for hearing loss, vision loss and other “occupational diseases” that arose from your job. Psychological and mental health injuries may also be covered if they are connected to a physical injury.
Acute injuries are typically related to a specific event like lifting something heavy, falling, or being injured by machinery.
Cumulative injuries result from repetitive work that wears on body parts over time.
Occupational Diseases are also covered under worker’s comp insurance. Examples include hearing or vision loss.
What to Do
If you notice pain or dysfunction that you think is related to repetitive work, report it like any other injury.
If you need help for an occupational disease or a repetitive stress injury, the insurance company is probably going to deny you or quickly cut off your benefits. But that doesn’t mean your case is over. A knowledgeable workers’ comp lawyer can help get your claim back on track.
What to Know
Yes, workers’ comp in Georgia does cover aggravation of pre-existing injuries. For example, let’s say you had a back injury in the past which was successfully treated. If your back becomes painful again because of work activity, that injury is covered.
However, insurance companies will frequently deny claims that involve pre-existing injuries.
What to Do
Report your injury. And when asked about pre-existing injuries, be open and honest. If the insurance company denies your just because of a pre-existing condition, don’t assume there’s nothing you can do.
What to Know
Georgia workers’ comp law sets wage replacement at two thirds of your average weekly earnings up to $800 weekly.
You can also receive “temporary partial” benefits to help make up for lost wages when your employer puts you on lower paying light duty work or they reduce your hours. This payment will vary from week to week based on how much you earn. Employers and insurance companies don’t like this because of the complexity, but it’s the law.
What to Do
If you’re getting a check for less than $800 per week, ask the insurance company for the documents they used to calculate your payment. They often get it wrong.
What to Know
Worker’s comp insurers in Georgia deny medical care all the time, especially when you need surgery. But a denial from an adjuster isn’t final. Your adjuster may deny medical care even when they admit you had a legitimate work injury. If they try this with you, talk to a workers’ comp attorney who understands the system and knows the doctors in your area.
What to Do
Gather all medical records related to your injury. Providers must give you these free. Also meet with a local workers’ comp attorney who can help you get important records, medical records and wage records.
What to Know
These are specific actions insurance companies often take even after they have accepted your claim and benefits are ongoing. Typically, this happens because of a change in the doctor’s notes. And often the change stems from actions by the insurance company—a new questionnaire, an interview, or a paid second opinion.
Overcoming such denial requires close examination of the changes, including why and how they were made. The resulting argument is often complex and legalistic. More than most people can manage without expert representation.
What to Do
Don’t accept any denial of benefits without challenge. Your attorney (and you REALLY need one here) can demand to have the specific reasons for the denial. The arguments behind denials are often not compelling, so they don’t hold up in court.
What to Know
Most workers’ comp insurers in Georgia will initially deny your claim if you have a positive drug test. HOWEVER, you can overcome the denial if you can show that drug use was not the immediate cause of your injury.
What to Do
Ask your employer to show you their written policy on testing for drug use. If the employer is testing only when there is potential for a workers’ comp claim, that may be a significant factor in your favor.
Note the time of your injury and the time of the drug test. If the test was not given within 8 hours of your injury, it is not admissible.
Refusing to be tested will not help your case.
What to Know
This is a complicated question that hinges on the nature of your injury, access to healthcare through other insurance and many other factors. Most cases do settle eventually. But keep in mind that Georgia Workers’ Compensation law does not entitle you to settlement, nor can the insurance company make you settle.
Sometimes, it does not make sense to settle If your injury is very serious and you need ongoing complex care for many years.
What to Do
When settling your case, you definitely need a lawyer with expertise in Georgia Workers’ Compensation law. And, if your case will involve ongoing (“catastrophic”) care you should find a lawyer who understands the complexities of Medicare set-asides.
What to Know
No, you cannot sue your employer for damages related to a work injury. You can make a claim for benefits, but that claim is not a lawsuit allowing for pain and suffering and other claims you might make in a personal injury claim.
However, it is possible in some cases to sue third parties who might have contributed to the injury. This sometimes happens on construction sites where multiple business entities are involved. Another example would be when a person is driving a vehicle as part of their job and they are injured by another driver.
What to Do
Don’t hesitate to pursue a workers’ comp claim because you feel guilty about “suing” your employer. A workers’ comp case is a claim for benefits from an insurance company who is receiving premiums from your employer. It’s not a lawsuit.
If you think a third party contributed to the injury, consult with an experienced workers’ comp attorney.
What to Know
Yes, as long as the work complies with the restrictions imposed by your treating doctor. If you refuse, the insurance company can cut off your benefits.
What to Do
Be familiar with the specific restrictions your doctor gave you and do the work as long as it’s within your restrictions. Insurance companies sometimes pressure employers to say they have “light duty” work even when they don’t.