A workers’ compensation eligibility lawyer can help you understand workers’ compensation guidelines. The first thing they need to determine is whether your employer carries workers’ compensation insurance. Next, we will make sure you understand the situation.
The Georgia State Board of Workers’ Compensation (SBWC) requires all businesses with three or more workers to carry workers’ compensation insurance. If you are unsure whether your employer has workers’ compensation insurance, you could search the Georgia SBWC database.
If you are unsure about your eligibility for benefits, our Atlanta eligibility guidelines attorneys could help. We offer free consultations that will help you understand who qualifies for workers’ compensation in Georgia.
Summary of Requirements That Determine Workers’ Compensation Eligibility
You will likely be eligible for Georgia workers’ compensation benefits assuming all of the following hold true:
- You were not intoxicated or otherwise impaired at the time of the accident.
- You did not intentionally cause the accident.
- You are employed by an organization that carries workers’ compensation insurance.
- You sustained an injury or occupational disease that is the result of your job.
For a free legal consultation with a eligibility guidelines lawyer serving Atlanta, call (404) 888-8888
Who Is Not Eligible for Workers’ Compensation in Georgia?
Employers with three or more employees are required to carry workers’ compensation insurance. However, some exceptions to this rule might apply to your situation. Those who are generally not covered under Georgia workers’ compensation laws include the following workers:
- U.S. government employees
- Farm laborers
- Domestic servants
- Railroad workers
- People who are self-employed
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Are Both Injuries and Illnesses Covered Under Workers’ Compensation?
Yes, workers’ compensation insurance covers both injuries and illnesses. Concerning illnesses, the Georgia State Board of Workers’ Compensation Employee Handbook states that if a disease meets certain tests imposed by the law, insurance can compensate the employee for that disease.
However, our workers’ compensation lawyers know there must be a relationship between the disease and the worker’s employment. In other words, the worker’s employment must have caused the disease.
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How Georgia Classifies Work Accidents
For covered injuries, Georgia generally uses two different terms to classify accidents: catastrophic and non-catastrophic. Injuries resulting from both catastrophic and non-catastrophic accidents are covered, but different benefit types could apply to each type of accident.
Catastrophic Injuries
Examples of catastrophic injuries covered under workers’ compensation include:
- Amputations
- Severe paralysis
- Severe head injuries
- Severe burns
- Blindness
- Injuries severe enough to prevent employees from returning to work
Non-catastrophic injuries comprise most other types of injuries. These tend to be injuries that do not permanently and completely prevent an injured worker from returning to some type of work.
Depending on the severity of your injuries, our workers’ compensation lawyers in Atlanta may be able to get you compensation for your wages from a temporary or permanent disability, along with your future wages.
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Types of Workers That are Ineligible for Workers’ Compensation
Georgia law states that some classes of Atlanta workers are ineligible for workers’ compensation. These classes include:
- Independent contractors
- Freelancers
- Consultants
- Farm laborers
- Railroad workers
- Longshoremen
- Volunteers
- Some domestic workers
These types of workers pay for their own income tax. The workers’ 1099 forms classify them as exempt, so they cannot receive workers’ compensation.
Key Factors That Affect Workers’ Compensation Eligibility
Your employer’s insurance company could deny your worker’s compensation benefits under certain circumstances, including:
- If you intentionally caused your injury or illness, perhaps under the influence of drugs or alcohol intoxication or impairment
- If your injury or illness resulted from your willful misconduct
Possibly, your employer denied your claim by arguing that you were impaired at the time of the accident. However, if your alleged impairment did not cause your accident, you could request a hearing to challenge this denial. Our workers’ compensation lawyers can help you with this effort.
How Georgia Considers Injuries When a Worker is at Fault
The Georgia State Board of Workers’ Compensation does not provide workers’ compensation benefits to injured workers willfully or negligently at fault for causing their workplace accident.
A workplace accident that could have happened to anyone in the same situation and one that resulted from an employee’s willful misconduct or negligence are different. The former type of workplace accident occurs when the employee is performing their standard work duties and or in some way related to the employee’s regular course of work.
The latter type of workplace accident happens when a worker engages in inappropriate behavior, gross negligence, or other bad acts—and injuries resulting from this type of accident are not covered by workers’ compensation benefits.
Bad Acts That Could Squash Your Workers’ Compensation Eligibility
Consider the following examples of a worker’s bad acts that could render them ineligible for workers’ compensation benefits.
Violating the Employer’s Employee Code of Conduct
Suppose your employer provided all the company’s workers with a code of conduct that includes workplace safety rules. Still, your injuries result from your failure to comply with this code of conduct. In that case, you could be ineligible for workers’ compensation benefits.
Getting Into a Physical Altercation with a Coworker or Boss
If you taunted, teased, or otherwise initiated a fight with a coworker or superior at work, your actions would likely constitute misconduct. The incident would not count as an accident. So, any injuries you sustain from the altercation would not be covered by workers’ compensation.
Working While Intoxicated
You could have been intoxicated (by drugs or alcohol) at work and experienced a work-related accident and injuries. You will most likely be ineligible for workers’ compensation benefits since your intoxication showed poor judgment.
There is a difference between a worker’s willful and voluntary intoxication and a worker who becomes intoxicated by exposure to chemicals or toxins in the workplace. The former would be ineligible for benefits if he or she became injured on the job.
The latter-scenario worker would be eligible, though. The intoxication and resulting injuries did not result from your willful actions.
Engaging in Horseplay in the Workplace
If you suffered injury because of horseplay or a prank you initiated, you would likely be ineligible for workers’ compensation benefits. However, if you were an unsuspecting victim of the horseplay or prank rather than a willing participant in the activity, you would likely be eligible for workers’ compensation benefits.
The horseplay or prank was not your own doing, and you were merely a victim of a coworker’s actions.
Suffering Injury from Off-the-Clock Accidents
If you were off the clock when you experienced an accident, you might be ineligible for workers’ compensation, since you were on the worksite when you were not supposed to be there.
For instance, workers who are on their lunch breaks or smoke breaks engage in non-work-related activities. If they suffer an injury while on break, they are often ineligible for workers’ compensation.
Certain facts and circumstances could entitle an off-the-clock worker injured on the work site to benefits. Our workers’ compensation eligibility lawyers will know whether your situation qualifies for this exception.
Becoming Injured on the Clock but While Deviating from Your Normal Duties
Suppose you were on the clock when you were injured, but your injuries resulted from doing something that represents a gross deviation from your normal work duties.
In that case, your injuries might not be eligible for workers’ compensation. This is because you were doing something outside of the scope of your job without authorization.
For example, a delivery driver who makes a personal stop at a store while on the clock and has an accident leaving the parking lot will most likely be ineligible for workers’ compensation benefits. This is because the driver’s actions did not fall within the scope of their job duties.
Other Factors That Could Affect Your Workers’ Compensation
Besides the basic terms of eligibility we have reviewed, other “after the fact” elements could influence your ability to collect benefits from your employer’s workers’ compensation plan.
Prompt Reporting
You must immediately report any on-the-job accident to your work supervisor. Failure to report your injury within 30 days of the accident could result in loss of workers’ compensation benefits.
Choice of Medical Provider
Georgia law requires your employer to post information about medical providers you can use to treat your injury or illness. You can choose from a list of physicians your employer has posted (they must provide at least six names).
You may also contact a representative from the Workers’ Compensation Managed Care Organization your employer has contracted for medical services.
Working at a Lesser Paying Job
In some cases, an injured employee recovers to the extent that they can return to work, but they must accept a job that pays less than their previous position because of their injury.
If you find yourself in this situation, you are still eligible for workers’ compensation, but it will be in the form of a reduced benefit. These benefits are not to exceed a weekly amount of $450 and not to endure beyond 350 weeks from the date of your accident.
Catastrophic Injury
If you sustain a catastrophic injury, you may be eligible to receive lifetime benefits. Otherwise, you could receive benefits for as long as 400 weeks.
Social Security Payments
You can receive both Social Security and workers’ compensation simultaneously. However, your Social Security benefits may decrease if you are receiving worker’s comp benefits.
Our Atlanta Workers’ Compensation Eligibility Guidelines Lawyers Can Help You
Eligibility for workers’ compensation benefits in Atlanta can be confusing, especially if you work for a small company or are unsure whether or not your employer carries workers’ compensation insurance. You might have questions about your injury being covered, particularly if it happened during work hours but off of the job site.
For answers to all your legal questions regarding workers’ compensation eligibility and how to apply, the workers’ compensation team at Bader Scott Injury Lawyers can help you. Call (404) 888-8888 for your free consultation.
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