Although the workplace is one of the most common places that people get hurt, no one expects to be in an on-the-job accident when they head to work, nor do they expect to develop a work-related illness. It just happens. And with the injury or illness may come a severe financial burden. So if you are in this situation, let a Georgia workers’ compensation lawyer from Bader Scott Injury Lawyers help you.
After all, this is why workers’ compensation insurance was created. These benefits provide much needed medical care and partial income replacement to help injured workers and/or their families financially stay afloat during the aftermath of a work accident.
What do I do after a work accident or illness?
Take action right away.
- Tell your supervisor about your injury. Be forewarned that if you do not inform them within 30 days after you sustained the injury, you will likely be ineligible for workers’ compensation benefits.
- Get medical care. You will have to visit an employer-approved doctor for your work-related injuries. Your employer should give you a list of physicians from which to choose. The only exception to the employer-approved doctor’s mandate is if your accident was an emergency situation. In this case, you can receive temporary care from any physician or facility.
- File a claim with the State Board of Workers’ Compensation (SBWC). Although not legally mandated, it is highly advisable to have a lawyer review your case prior to filing. Bader Scott Injury Lawyers will make sure you do not make any mistakes on your claim and that you get the full amount of benefits to which you are entitled.
- Set up a consultation with us. We want to go over your case with you so you are prepared for whatever lay ahead. Read on to learn how we help our clients manage their cases and prove that they deserve benefits, even if the workers’ compensation insurance company denies their claim.
We Make Sure You Get All the Benefits You Deserve
Georgia workers’ compensation insurance laws, detailed in Georgia Code Title 34, Chapter 9, provide for several categories of benefits that you may receive.
- Medical benefits – Workers’ compensation covers all of your authorized hospital bills, lab work, doctor’s bills, and physical therapy, prescriptions, and necessary travel expenses so long as your injury occurred on the job. If you already paid medical bills, then you are entitled to reimbursement for those expenses.
- Income replacement benefits – If your injury causes you to miss more than seven days of work, you are entitled to income replacement checks. The duration of your eligibility for benefits depends on the nature, severity, and scope of your injury/disability. You may recover temporary total disability, temporary partial disability, or permanent partial disability.
- Rehabilitation – If you are no longer able to perform the same job you had prior to injury because of your disability, workers’ compensation will also pay for certain vocational rehabilitation services so that you can obtain training and return to the workforce.
The amount and types of benefits you can recover largely depends on the details of your case. Let us investigate your case so we can identify all of the benefits you deserve and ensure you receive a fair medical evaluation and impairment rating.
We Help You Get Catastrophic Injury or Death Benefits
Georgia specifies that workers who suffer catastrophic injuries are entitled to benefits indefinitely or until able to return to work. Ensuring the correct classification of an injury as catastrophic is vital because otherwise, benefits stop after 400 weeks. Examples of injuries that Georgia considers catastrophic are spinal cord injuries causing paralysis, severe brain injuries, amputations, severe burns, and more.
Insurers may vaguely interpret eligibility requirements, though. That is why it is so important to establish a thorough case backed by medical evidence. We work with medical experts and collect all the necessary evidence we need to make our argument that your injury is, in fact, catastrophic under the state’s requirements.
Meanwhile, if a worker died because of a work accident or illness, the deceased’s family will receive death benefits that include income replacement and funeral and burial expenses. The deceased’s spouse and minor children may qualify as beneficiaries. The spouse may receive benefits until he or she remarries or cohabitates with a partner, while the children get benefits until they turn 18 or 22 if enrolled in school.
We Make Sure You File Your Claim Correctly
Of course, to receive any of these benefits, you need to file your workers’ compensation claim and follow the procedures set forth by the state.
You must do so within the specified statute of limitations – otherwise you could be barred from recovering benefits. This varies depending on the situation. For example, the statute of limitations for most cases is one year from the accident. But if you already filed your claim and your condition worsens, then you must file a claim to recommence your benefits within two years of the date the last payment was made.
One of the most important aspects of your case is proving eligibility. Generally, you must meet a few requirements to qualify:
- You were not intoxicated at the time of the accident.
- You did not act intentionally to cause your accident.
- Your employer carries workers’ compensation.
- You suffered an injured or occupational disease within the scope of your employment.
Keep in mind also that certain employees are not covered by workers’ compensation, such as domestic servants, U.S. government employees, farm laborers, railroad workers, and anybody who is self-employed.
Whatever your case, work with us to make sure you meet all deadlines, follow the right procedures, and establish a case to prove you meet the eligibility requirements. The requirements might seem straightforward, but insurers may use various arguments to deny or complicate workers’ compensation claims.
We Help if Your Claim is Denied
A workers’ compensation insurance company may deny a claim for a number of reasons, some legitimate, some not. This includes things such as failing to inform your employer within the allotted time frame, overstepping the statute of limitations on your claim, and making mistakes or omissions on your claim.
Here are a few more reasons that an insurer might use to deny your claim.
- Arguing the injury or illness is not work-related.
- Claiming the worker is not actually an employee, but rather an independent contractor.
- Trying to prove the injury or condition is pre-existing.
- Asserting that the injury is exaggerated or fabricated.
- Blaming the accident on the worker’s horseplay or intoxication.
If you have a ton of medical bills and still need time to recuperate before you head back to work, it can be quite the shock and scare to get a letter in the mail that the insurer is denying your claim. If this happens, do not panic; there is an appeals process so that you can have another chance to prove your entitlement to benefits. If you have not done so already, this is the time you will most definitely want to call Bader Scott Injury Lawyers.
We explain the appeals process, help you gather supportive evidence, and then walk you through the steps. Your letter of denial from the insurer will state the reasons for denial. We can help you request a hearing from the SBWC. The Board will set a date for a hearing. Then, in the interim, your lawyer can help you collect adequate evidence to support your claim and then present it appropriately at the hearing.
We Help You Prepare for and Handle Any Court Hearings
Most workers’ compensation court hearings are necessary because the insurer denied the worker’s claim. Many hearings arise because the employee’s condition worsened or because the employee is trying to prove that his injury qualifies as catastrophic, and therefore qualifies for the lifetime benefits described above.
A hearing provides you and your attorney the opportunity to present evidence proving that the injury is work-related and that you qualify for workers’ compensation benefits. An administrative law judge (ALJ) will oversee the hearing and ultimately make a decision regarding your case; there is no jury present in ALJ hearings. We will represent you at the hearing. Also expect a representative from the employer as well as a representative and attorney from the workers’ compensation insurer.
The hearing is very much like other court cases. It includes a discovery period prior to the hearing. You may also have to give a deposition. At the actual hearing, each side will present evidence and call witnesses to make their case. Witnesses that we might call to support your claim include co-workers, medical experts, vocational experts, and more. At the end, the ALJ will make a decision.
If you disagree with the ALJ’s decision, then we can help you continue the appeals process with the SBWC.
While we can help at any stage of your workers’ compensation claims process, an attorney is especially important if you are preparing for a court hearing with an ALJ.
We Help You Deal with Whatever Challenges Arise
You are not required to hire a workers’ compensation attorney to file a claim or appeal a denial. But in most cases, a lawyer can be very helpful to ensure you exercise all of your rights, build a solid case to prove your entitlement to benefits, and handle any issues that arise throughout the process. There are lots of factors that can complicate a claim and increase the likelihood of running into speed bumps with your benefits.
- What if your injury is difficult to prove? (e.g., soft tissue injuries, pain conditions, etc.)
- What if the insurance company claims your condition was pre-existing and not work-related?
- What if the insurance company incorrectly tabulates your income replacement benefits? Did they include your regular overtime when calculating your average weekly wages?
- What if your disability rating winds up being much lower than it should be?
- What if you go back to work, but your condition worsens again?
- What if you inadvertently do or say something after the accident or during the claims process that thwarted your rights to benefits? (e.g., missed medical appointments, not sticking to your treatment plan, etc.)
- What if your treating doctor okays you to return to work but you are honestly not well enough yet?
See how quickly things can go wrong? Bader Scott Injury Lawyers works to preempt many of these issues and preserve your rights and best interests. And if they do arise, we help you manage and overcome them. Plus, when you have a lawyer, you will be able to rest a little easier knowing that you do not have to handle any legal issues on your own; you will have an advocate who is on your side, protecting what is important to you.
Georgia Small Business Act
According to a recent OnGeorgia article, the PGSBA was passed in response to an action taken by the National Labor Relations Board (NLRB) in August of 2015, which refined the standard used for determining joint-employer status. The NLRB reasoned that the changing environment of today’s workplace and economy called for increasing a company’s control over contractors and subcontractors. The definition of a joint-employer was broadened by the NLRB to include any company that (1) could exercise control over another company’s terms and conditions of employment – whether or not it actually does so; or (2) exercises this control through a third party.
The PGSBA specifically addresses and prohibits franchisors from interfering in a franchisee’s day-to-day management, such as hiring and firing. Because federal law trumps state law, the PGSBA would only apply to matters concerning state law – such as workers’ compensation insurance.
Georgia is not alone in pursuing legislative efforts regarding the NLRB’s definition change. Similar bills have been introduced across the nation including the states of: California, Massachusetts, Colorado, Oklahoma, Pennsylvania, Virginia and Vermont. Beyond these states, legislators in North Carolina, Wyoming, Arizona are evaluating similar legislative action.
Independent Contract Worker versus Employee
It is important to understand your work classification, particularly if you are seeking Georgia workers’ compensation benefits. This is because independent contractors – unlike employees – are not covered for on-the-job injuries by workers’ compensation insurance.
If a majority of one’s income comes from one company, the relationship with the company appears permanent, and the worker has no bargaining power regarding his or her terms of employment, he or she is likely an employee. This would be the case even if the company categorizes the individual as an “independent contract worker.”
An independent contract worker is someone who has the right to control and direct the most important aspects of his or her job. A contract worker generally receives a 1099 at the end of the year, pays his or her own self-employment tax as well as income tax. Conversely, an individual is an employee if he or she receives a W2 at the end of the year and the paying entity has the right to direct and control the worker’s activity regarding finances, behavior and the relationship between the parties.
Learn More about Georgia Workers Comp Law
To learn more about workers’ compensation, visit the SBWC’s website and download a copy of the SBWC Employee Handbook. For an easier, much more employee-friendly read, you can request a free copy of Seth Bader’s book, 9 Common Mistakes That Can Destroy Your Workers’ Compensation Case and How To Avoid Making Them.
Then call our office today for a free case evaluation. Let us review your case, determine your choices, and then devise a plan of action. Contact us at 678-562-5595 to get started.