Steps to Filing a Workers’ Compensation Claim
After a workplace accident, it’s easy to feel overwhelmed and unsure of exactly what steps you should take next. Workers’ compensation claims in Georgia require following precise steps with deadlines that, if missed, can bar you from recovering the compensation you need.
To make the workers’ compensation process a bit less intimidating, we have created a simple guide to the steps involving in filing a workers’ compensation claim in Georgia.
If you need assistance with filing your claim, or your claim has been denied, an Atlanta workers’ compensation lawyer at Hasner Law, PC is here to help.
Steps to File a Workers’ Compensation Claim in Georgia
Filing a claim for workers’ compensation benefits is generally straightforward, although the claims process after filing can be complicated if your claim is not automatically accepted.
The following are the steps you must take to file a claim to receive workers’ compensation benefits in Georgia.
1. Notify Your Employer
The first and most important step you must take is notifying your employer about your injury or occupational illness. Your supervisor or employer must be notified within 30 days, but the sooner they are notified, the better.
Even if you think you were not seriously injured at work, it’s still important to report any workplace accidents to your employer. This protects you if the deadline passes and you realize that you were more hurt than you realized.
It isn’t enough to verbally notify your employer: the notification should be done in writing. This will create a record that helps support your workers’ compensation claim.
2. Obtain Medical Treatment
It’s important to seek medical treatment as soon as possible after your injury. While you generally cannot choose your own doctor for treatment that will be covered by workers’ compensation, there are exceptions.
Your employer and the workers’ compensation insurer must pay for any emergency medical treatment you needed to receive after your accident.
If you must see a doctor right away, you can visit your nearest hospital or urgent care.
Otherwise, your employer should provide you with a list of approved physicians you can see. You can see a doctor of your choice for non-medical treatment only when this list is not provided within a reasonable amount of time.
If you do not use a physician on the approved list, it can be used as a reason to deny your claim for benefits.
While receiving medical attention, make sure you make all of your appointments and follow all work restrictions and medical advice you are given.
3. File Workers’ Compensation Claim Form WC-14
Your employer should provide you with an official WC-14 form to complete or you can request one from the State Board of Workers’ Compensation.
The WC-14 form will ask for information such as:
- The location and nature of the injury you sustained
- How the accident occurred
- The location, time, and date of the injury
- Anyone else who was involved in the incident
- Any medical treatment you have already received
This form is filed with the State Board of Workers’ Compensation. You should also send copies to the employer and the workers’ compensation carrier.
4. Your Employer Will Submit Your Claim
Once the form is submitted, your employer will complete the next steps. Employers who are required to carry workers’ compensation insurance face stiff penalties if they do not complete their responsibilities. They are also forbidden from retaliating against you for filing a workers’ compensation claim.
After your employer files the claim and other paperwork with their insurance carrier and the State Board of Workers’ Compensation, the insurance carrier will evaluate your claim. You will be notified about whether or not your claim is accepted.
What Happens After Filing a Workers’ Compensation Claim?
Your case isn’t over when your claim is submitted. Your lawyer will help you submit documentation, written statements, and oral testimony about your accident or illness. You should continue to receive any medical treatment your physician recommends. It is also wise to keep a journal of your recovery, how the injury affects your life, receipts for related costs, and proof of how your quality of life is impacted.
Benefits You May Receive
As an injured worker, you may be entitled to receive three primary types of workers’ compensation benefits.
- Medical benefits cover medical treatments for up to 400 weeks after the date of the accident, not counting catastrophic injuries. You will have no out-of-pocket costs with payments made directly to medical providers.
- Indemnity benefits cover your lost wages while you are unable to return to work or must work less.
- Permanent partial disability (PPD) benefits are paid if you receive a PPD rating from an authorized treating physician. This benefit is based on the workers’ compensation rate and the body part injured.
The weekly income benefits you can receive through workers’ compensation are capped depending on whether you have temporary total disability (TTD), temporary partial disability (TPD), or permanent partial disability (PPD).
TTD is calculated as 2/3 of your average weekly wage up to $675 for up to 400 weeks.
Catastrophic injuries, however, can qualify for lifetime benefits. TPD is 2/3 of your average weekly wage up to $450 for up to 350 weeks.
PPD is 2/3 of your average weekly wage up to $675. The maximum number of payments depends on the type/location of the injury and it can be paid weekly or in a lump sum.
Settling a Workers’ Compensation Claim
Your workers’ compensation lawyer will work with the insurance company to reach a fair settlement. While workers’ compensation claims are ultimately heard before an administrative law judge, most cases are settled before they reach court.
When a workers’ compensation claim is settled, it means the insurer, rather than paying all of the benefits such as medical care, mileage, and temporary disability, pays instead a flat amount of money. The insurer may agree to pay for medical benefits over a specific time period such as 3 to 12 months.
Most workers’ compensation settlements in Georgia are paid as a lump sum. The insurance company may also agree to a structured settlement. This is usually beneficial if you suffered serious and permanently disabling injuries requiring long-term care. In this case, rather than one lump sum payment, you receive payments each month or once a year.
If you accept a settlement of your workers’ compensation claim, you give up the right to your claim in the future. This includes the right to claim for future medical treatment. You are not able to make a claim for additional money if your condition worsens.
All settlements in Georgia must be approved by the State Board of Workers’ Compensation. Documents are filed with the board including a stipulated settlement agreement explaining the terms, claims forms, medical records, and your attorney’s fee agreement.
Your workers’ compensation lawyer will help you decide if a settlement is in your best interests by explaining the ramifications, when you will receive the funds, what they believe your claim is really worth.
Independent Medical Exams
The insurance company will also want to verify the severity of your injuries and determine if you are able to return to work. If there is any dispute about the treatment you receive or your injuries, you may be asked to complete an independent medical examination (IME). Workers’ compensation insurers in Georgia have the right to request an IME when reasonable.
The purpose of the IME is to get a medical opinion that is favorable to the insurance company. They may request this exam to avoid paying for costly medical treatment or have you return to work sooner than the doctor has recommended. If you do not complete this exam, you risk losing your workers’ compensation benefits.
Appealing a Denied Workers’ Compensation Claim
If your employer denies your workers’ compensation claim, you have the right to file a claim with the State Board of Workers’ Compensation to request a hearing before an administrative law judge. These hearings are usually scheduled within 60 days.
When you appeal a denied workers’ compensation claim, notice is sent to all parties. Before the hearing takes place, there will be a discovery phase during which both parties can submit requests for documentation and interrogatories or written responses.
A workers’ compensation hearing works like a civil lawsuit except there is no jury, only a judge, and the judge cannot award a settlement to either side. Instead, the judge is a trier of fact and can rule on whether a claim is compensable. They may, however, award certain expenses and benefits such as medical treatment, permanent partial disability benefits, and penalties.
Do You Need a Workers’ Compensation Attorney?
You are never required to hire a workers’ compensation attorney in Georgia, but it can be challenging to enforce your right to workers’ compensation sometimes. There are complicated rules that must be followed and the insurance company will use any method it can to undervalue or deny your claim.
A Georgia workers’ compensation lawyer can protect your interests and serve as an advocate to fight for the full compensation you are entitled to receive. Your lawyer can help you file your claim, provide valuable legal guidance throughout the process, and appeal a denied claim.
Have you been hurt in a workplace accident? Get the help you need filing or appealing your claim with the Georgia workers’ compensation attorneys at Hasner Law today. Call our law office for a free consultation to discuss your case.