Stephen Hasner | Workers' Compensation | July 15, 2021
Forty-nine states require employers to buy workers’ compensation insurance, including Georgia. Workers’ comp insurance provides medical, income, job training, disability, and death benefits to workers who are injured on the job.
But these benefits do not come automatically. You have a role in claiming these benefits; even simple mistakes can affect your claim.
Here are six mistakes you should avoid after an on-the-job injury:
Assuming that You Can Sue Your Employer
If your employer complies with Georgia law, workers’ comp provides your exclusive benefits after a workplace injury. You cannot file a lawsuit against your employer, regardless of whether your employer was negligent.
To receive any benefits from your employer for your injury, you must go through the workers’ compensation system. But in certain circumstances, you can receive compensation from outside parties that contributed to your injury.
For example, suppose that you suffered an injury in a workplace accident when a defective scaffold collapsed on you. Under Georgia law, you can file a product liability lawsuit against the manufacturer of the scaffold. In short, you can sue third parties who contributed to your accident.
But a lawsuit will take time. You will need medical treatment while you wait for a settlement or damage award. You will also need income replacement. Fortunately, You can get these benefits by filing a workers’ compensation claim.
Failure to Report the Accident
Georgia law requires you to give notice of your accident within 30 days after the injury. You can give notice in person or in writing to your employer. You do not need to give notice directly to the company’s owners. Instead, reporting the accident to your supervisor or foreman will satisfy this legal requirement.
You cannot receive any benefits for medical treatment until you give notice. If you went to the emergency room after your accident, you will be liable for the fees arising from the ambulance and ER visit until you give notice.
More importantly, you can lose your workers’ compensation benefits altogether if you fail to report the accident within 30 days after your injury.
Georgia law excuses some causes for delay, including:
- Physical or mental incapacity
- Fraud or deceit
- Employer knowledge of the accident
- Another reasonable excuse that did not prejudice the employer’s rights
If none of these reasons apply, you cannot wait to report your accident.
Hiding Your Injury
Some workers hide their injuries after an accident. Workers have many reasons for wanting to hide an injury, including a bruised ego or peer pressure to “tough it out.” But suffering through an injury could have long-term consequences.
You might have injured yourself more severely than you realize. A sore back might be caused by a compressed or ruptured disc. Without treatment, you could suffer nerve pain for the rest of your life.
Some workers worry that their employer will fire them for getting injured on the job. An employer can fire you for violating safety rules, endangering other workers, or for reasons that are unrelated to your workers’ comp claim.
But your employer cannot fire you in retaliation for:
- Reporting an unsafe workplace
- Reporting an on-the-job injury
- Filing a workers’ comp claim
Hiding injuries could cost you valuable workers’ comp benefits because you can only receive benefits for reported injuries. And if you hide your injury for longer than 30 days, you will lose the right to file a workers’ comp claim.
You should always include all injuries when you report an accident to preserve your right to claim your legally entitled benefits.
Failure to Seek Medical Treatment
Medical treatment is central to a workers’ comp claim. Your primary benefits include full payment of all reasonably necessary medical treatment, therapy, and medication.
Without medical treatment, you might not heal from your injuries. More importantly, you might not receive the diagnosis necessary to receive income replacement, disability, or other long-term benefits.
In Georgia, your employer and its workers’ comp insurer can limit your options for medical providers. The employer can give you a list of providers or enroll in a Workers’ Compensation Managed Care Organization (WC/MCO). You must receive treatment from an approved provider for the insurer to pay for your medical bills.
Accepting a Denial of Benefits
Georgia’s workers’ compensation laws encourage insurers, employers, and employees to settle claims. They also encourage insurers and employers to review claims reasonably.
But insurers still deny claims. Sometimes, this happens because reasonable minds come to different conclusions about the cause or severity of an injury. But other times, this occurs because insurers save money by denying claims.
You have the right to have your claim reviewed by the Georgia State Board of Workers’ Compensation. The board can order you and the insurer to mediate the claim or assign an administrative law judge (ALJ) to hear the facts surrounding your claim.
The ALJ can reverse the insurer’s denial of your claim. More importantly, if the insurer denied your claim without reasonable grounds, the ALJ can order it to pay your attorney fees and litigation costs. This means that you might not need to pay your lawyer if you win your case.
Fighting for Benefits Without Legal Representation
Without legal representation, you risk losing your right to claim benefits. Once you have received benefits, you could also have your benefits reduced or terminated.
For example, your employer and its insurer can request an independent medical examination. Refusing to attend the examination or attending without first consulting a lawyer could expose you to reduced workers’ comp benefits.
Your employer will receive case progress reports and can request that you return to work when you have recovered from your injuries.
Refusing to return to work or returning to work without first requesting reasonable accommodations for your injury can put your benefits and other legal rights at risk.
Hiring a lawyer before returning to work will ensure that you avoid subsequent injuries and preserve your legal rights.
Working Within Georgia’s Workers’ Comp System
Georgia designed its workers’ compensation system to balance the rights of employees and employers. As a result, you could run into obstacles as you pursue your claim.
Navigating these obstacles will require a thorough knowledge of the workers’ comp system and experience with its procedures. Hiring a lawyer can provide invaluable guidance as you pursue your workers’ compensation claim.