Does “Fault” Matter in Workers’ Compensation?
Workers’ compensation injury insurance is a “no-fault” program. It is not necessary to prove negligence or responsibility. The critical element in a workers’ comp claim is that you were on the job when you suffered an injury. While it should make receiving your benefits less complicated it also means that your employer or claims adjusters may attempt to deny you some or all of the coverage you deserve.
- I was Injured at work. Am I entitled to workers’ compensation?
In Georgia, the law requires any business with three or more employees, including regular part-time employees, to carry valid workers’ comp insurance. The insurance carrier is the entity that pays benefits to an injured worker. You are eligible for workers’ comp benefits if:
1) you are an employee of a business with three or more employees, and
2) you suffered an injury while on the job.
- I was injured at work… What do I do next?
While Georgia law sets forth the procedure that employers, insurance companies, and injured workers must follow, it is important to note that each claim is unique and that worker’s comp law is complex and always subject to change. It is so critical to obtain the advice and counsel of a skilled workers’ comp attorney who is experienced in handling claims from beginning to end.
In general, after a work injury, you should take the following steps:
- Seek medical assistance as soon as possible.
Your health is the most important thing you should be concerned with, so, if you are injured on the job, seek medical attention as soon as possible. In the case of an emergency, you may seek medical treatment from any doctor. However, in non-emergency situations, you may have to seek treatment from a specific healthcare provider, depending on the insurance carrier’s requirements. It is important for you to follow the advice of your doctors
- Notify your employer about the accident and your injuries.
State law requires that you, as an injured employee, must notify your employer as soon as possible following a workplace injury, and in no circumstances, later than 30 days following the accident/injury. Failure to notify could lead to a forfeiture of your workers’ compensation rights of recovery.
- Upon notification of your injury, your employer will file a workers’ comp claim with its insurance carrier.
Once your employer is notified of the accident/injury, it must notify both its workers’ comp insurance carrier and Georgia’s State Board of Workers’ Compensation of the incident.
- Once your employer files the claim, the insurance carrier will either accept or deny the claim.
If the insurance company accepts (i.e., approves) your claim, you will begin to receive workers’ comp benefits within a timeframe specified by Georgia law. If the insurance company denies your claim, it must provide you with detailed reasons as to why it was denied. If your claim is denied, you must act quickly to determine whether you wish to appeal the insurance company’s decision. An experienced workers’ comp attorney will help you evaluate your claim and provide guidance as to whether you should appeal the denial.
- You can appeal the insurance company’s denial of your workers’ comp claim.
If the insurance company denies your claim and determines that you are not entitled to receive benefits, you may request a hearing before the State Board of Workers’ Compensation. The hearing is similar to a trial, but it is heard before an Administrative Law Judge (ALJ). The ALJ hears from both you and the insurance company, applies the relevant law, and then renders a written decision as to whether you are entitled to workers’ comp benefits. This hearing is very important to your claim and you can assume that an experienced attorney will represent the insurance company. It is important to be prepared, and you will certainly
- If you “lose” at the ALJ hearing, you may appeal the decision to a Georgia court.
If the ALJ affirms the insurance company’s denial of your claim, you may be able to appeal the decision to the appropriate appeals court. This is a time-sensitive and complex procedure. It is highly advisable that you have an experienced attorney during this process.
What Benefits am I Entitled?
Georgia’s workers’ comp system is considered “no fault,” meaning that specific benefits are offered to workers injured on the job, regardless of fault. Generally, benefits provided to employees fall into the following categories:
- Reimbursement for Medical Expenses.
The workers’ comp insurance carrier generally should pay for your medical expenses incurred as a result of your injuries. This includes treatment and prescriptions. You may also qualify for “travel expenses” under certain circumstances. You are eligible to receive reimbursement for medical expenses for up to 400 weeks after you sustain your injury. In cases of catastrophic injuries, medical reimbursements could be indefinite.
- A percentage of Lost Wages.
Typically, during the time when an injured employee is out of work, he or she should receive two-thirds of his or her average weekly wage, but not more than $575.00 per week for an accident that happened on or after July 1, 2016. Your average weekly wage is calculated taking into account your total gross earnings before taxes and benefits for the 52-week period prior to the accident.
My Spouse Died as a Result of Work-Related Injury.
Can I Receive Any Benefits?
The dependents of an employee killed as a result of work-related injuries sustained after July 1, 2016, will receive two-thirds of the employee’s average weekly wage or up to $575.00 per week, whichever is less.
Georgia law defines dependents as the employee’s surviving spouse, children, and dependent stepchildren.
A spouse who does not have children may receive a limited benefit amount, totaling up to $230,000.00 (unless and until he or she remarries or “cohabitates” in a marital-like relationship).
Please contact The Cossio Law Firm if you or your loved one has been injured or killed while on the job. We are here to help you.