The law in Brookhaven and around the rest of the state requires employers with three or more employees to provide workers’ compensation insurance policies to those workers. These policies can provide a variety of benefits such as medical care, temporary wage reimbursement, and payments for permanent injuries.
Sadly, as with any other insurance program, providers are hesitant to pay out benefits unless they need to. This could lead to a variety of disputes over the severity of an injury, the appropriate benefits, or even whether the incident was related to doing a job. It is in these times that a Brookhaven workers’ compensation lawyer may be able to help.
The legal professionals at Bader Scott Injury Lawyers understand the state’s workers’ compensation laws. We can help interpret the reason for your denial or why the insurance company has offered limited benefits. We can then take the lead to pursue an appeal with the State Board of Workers’ Compensation to seek out the payments that you deserve. Give us a call to learn more.
When and Where an Attorney Could Help
Unfortunately, denials are common in the world of workers’ compensation insurance. However, regardless of the reason why an insurance company denies a claim, all workers have the right to seek out an appeal.
You Could File an Appeal if Your Claim is Denied
These appeals occur before the State Board of Workers’ Compensation. To initiate the process, a lawyer can file a formal request for an appeal before a judge.
Even so, many cases do not get to this point. The Board may require the worker, the employer, and the insurance company to participate in mediation sessions in an attempt to settle the claim out of court. An attorney can help protect your interests during these sessions.
It is only if these sessions fail to bring a result that a full trial will occur. During these trials, all parties will have a chance to provide an official statement, present documentary evidence, and question witnesses.
If this session still fails to bring appropriate benefits, it is possible to pursue a second appeal with the Appellate Division of the Board. In short, a Brookhaven workers’ compensation lawyer can work to press for your rights during every legal proceeding.
Exploring Reasons for Why an Insurance Company Might Deny a Claim
Every denial letter that an insurance company issues on a claim must include a reason for that denial. Properly identifying the reason for a denial is always the first step in any workers’ compensation case.
There is No Connection Between a Condition and a Job
Benefits are only appropriate when a person suffers an injury or illness connected to doing one’s job. A failure to make this connection can lead to a total denial of benefits.
According to OCGA §34-9-80, all workers who suffer an on-the-job injury or illness must report the incident to the employer no more than 30 days after the fact. In addition, employees must also complete and submit form WC-14 to notify the State Board of Workers’ Compensation about the incident. Failure to take these steps could lead to a dismissal of the claim.
Even if a worker follows these steps, the insurance company may still doubt the story. They may argue that the injury occurred while off the clock or was the result of horseplay. These scenarios also provide a justification for a denial of benefits.
Disputes Over the Severity of an Injury or Illness
The other main reason for workers’ compensation disputes is whether the incident was serious enough to merit benefits. Under state law, all claimants must miss at least seven days of work before they can start to receive benefits.
It is a common tactic of employers and insurance companies to convince employees to attempt a return to work to avoid payments under this caveat of the law.
Successfully completing this waiting period authorizes the payment of benefits and missing at least three weeks in a row will make you eligible to receive benefits for this initial week. A lawyer can help identify the reason for your workers’ compensation denial.
Helping Workers to Receive Appropriate Benefits
Benefits in workers’ compensation cases come in two main forms. First, an injured or ill employee should receive all necessary medical care to make their best recovery. This medical care should come at no cost to them.
In addition, many injured or ill workers can expect cash payments. Some of these payments come in the form of temporary disability benefits. These pay out at a rate of 2/3rds one’s average weekly wage prior to the incident and last for the duration that a person is out of work.
Payments can also result from permanent partial or total disability. Here, payments may continue for the extent of one’s disability and the amount will depend on the exact nature of the illness or injury. A lawyer could help determine whether an offered compensation package is appropriate.
Our Attorneys Could Help Protect Your Legal Rights After a Workplace Accident or Illness
Most employees in Brookhaven and around the state enjoy protection under a workers’ compensation insurance policy. These policies can provide medical treatment and cash payments if an incident keeps a person out of work and occurred due to performing one’s job.
If you have received a denial of benefits, or believe that a benefits package is insufficient, a Brookhaven workers’ compensation lawyer may be able to help you. We can work to determine the reason for your denial, take the lead in filing an appeal, and represent your interests every step of the way.
Reach Out to the Legal Team at Bader Scott Injury Lawyers Today
We are ready to provide a free consultation and to take every necessary step to obtain the benefits that you deserve. Give us a call today at (404) 888-8888 to learn more.