In Georgia, filing a workers’ compensation claim involves promptly notifying your employer of your work-related injury or illness, seeking medical care from an authorized provider, and (when necessary) completing paperwork and sending it to the Georgia State Board of Workers’ Compensation (SBWC), your employer, and their workers’ compensation insurance company.
Unfortunately, Georgia does not make claiming workers’ comp benefits easy. The state uses numerous technical forms to document claims, and workers frequently run into roadblocks trying to get paid for their care and lost income. (It doesn’t help that the internet contains confusing and contradictory information about the process.)
Here’s an overview of the Georgia workers’ compensation claim process and why you need an experienced workers’ compensation lawyer to secure maximum benefits when you get hurt or sick on the job.
Workers’ Compensation Overview
Workers’ compensation is a form of insurance paid for by your employer. It covers some of the costs of getting hurt, sick, or dying in connection with your job. By law, all employers in Georgia with three or more workers (including regular part-time workers) must carry workers’ compensation insurance.
An employer’s failure to carry workers’ comp can expose them to fines and other penalties. You can find out if your employer carries workers’ compensation coverage on this Georgia State Board of Workers’ Compensation (SBWC) website.
Who Workers’ Comp Covers?
Workers’ comp covers everyone working for a qualifying employer, regardless of how many hours they work, age, job duties, or immigration status. If you work for a business or individual in Georgia who employs at least three people, including you, chances are you are covered by workers’ comp (or should be). Workers’ comp covers you even if you are in the country illegally.
What Injuries and Illnesses Workers’ Comp Covers?
Workers’ compensation protects against any injury or illness you suffer in connection with performing your assigned job duties in Georgia.
- Physical injuries you suffer in an on-the-job accident like a fall, equipment malfunction, or motor vehicle crash;
- Physical injuries from performing job duties like lifting, kneeling, reaching, or sitting for long periods;
- Burns and other injuries from working around open flame, hot liquids or objects, or caustic chemicals;
- Illness or injury due to an unsanitary or unreasonably hot or cold work environment;
- Illness or injury resulting from short- or long-term exposure to toxic materials, chemicals, or environmental conditions; and
- Dying due to any of the above.
With limited exceptions (see below), the law entitles you to receive workers’ comp benefits no matter who was at fault for the accident, incident, or work condition that led to your health problem or death, even if it was you.
Workers’ compensation insurance does not protect against injuries, illnesses, or deaths suffered while on break, during a commute to or from work, or while performing unassigned job duties.
Workers’ comp will not cover you if you get hurt or sick or die while engaging in misconduct (such as fighting or horseplay), through self-harm, due to the willful act of a third party for personal reasons (for example, you get attacked by a coworker who has a personal beef with you), or due to abusing drugs or alcohol.
Workers’ Comp Benefits
Workers’ compensation insurance offers several benefits for injured workers and the families of workers who die from work-related causes.
- Payment for all medical care for your injury, illness, or condition you receive from a provider authorized by your employer, including hospital stays, surgery, rehabilitation/therapy, medication, and medical equipment.;
- Reimbursement of certain expenses related to traveling for medical care, such as mileage, meals, and lodging.
- Temporary total disability benefits replace two-thirds of your average weekly income until you can work again provided the disability lasts at least seven days. For non-catastrophic injuries, the maximum benefits period is 400 weeks.
- Temporary partial disability benefits replace two-thirds of the difference between your average weekly income and your reduced income due to a disability, provided the disability lasts at least seven days.
- Permanent partial disability benefits that compensate you for a permanent disability resulting from an on-the-job injury or health condition. The amount of the benefit is calculated based on your percentage of disability as determined by a medical provider.
- Death benefits replace two-thirds of the deceased worker’s average weekly wage up to a maximum set by law, payable to a dependent spouse or minor child. In addition, death benefits include the cost of a funeral or burial up to a maximum set by law.
- In some cases, job retraining and rehabilitation benefits.
You cannot combine income replacement disability benefits, which are only payable one at a time. If you file a prompt claim, you should begin receiving any disability benefits for which you’re eligible within 21 days of becoming disabled.
You Notify Your Employer
Georgia’s workers’ comp claim process starts when you notify your employer (your boss, manager, or supervisor) about your injury or illness. To protect your rights to benefits, you should do this immediately after getting hurt or realizing you’re suffering from an illness or health condition linked to your job.
Any unnecessary delay in telling your employer about your health condition can complicate receiving benefits. You risk losing your right to benefits if you wait more than 30 days.
Be sure to report your injury or illness to your boss, manager, or supervisor in writing (not just orally). Your employer may have paperwork for you to fill out for this purpose. If so, complete and return it right away. If not, write a summary of what happened (time, date, location, nature of incident, injuries you suffered) and submit it to your employer as soon as possible.
You Seek Medical Care
Seek immediate medical care for any work-related injury or illness. Any delay can complicate your claim or result in losing your rights.
In Georgia, you must seek treatment from a medical provider authorized by your employer, except when you need emergency care. Workers’ comp will not pay for your regular doctor unless your employer happens to authorize that doctor (which is unlikely).
Your employer must post a list of approved medical providers at your workplace. Consult that list, pick a provider, and schedule an appointment right away. You can switch to another provider on the list once without seeking your employer’s approval, but any additional switch may require your employer’s or the workers’ comp insurance company’s sign-off.
Notify your employer immediately if you encounter difficulty scheduling or receiving care from an authorized provider, such as a long wait time for an appointment or being told they can’t treat your condition.
Workers ‘ comp should pay for any care you receive from an authorized medical provider for a covered health condition. The provider will usually bill and get paid directly by your employer’s workers’ comp insurance company. If you pay any medical expenses out of pocket (including for medications or expenses traveling to get care), submit bills and receipts to your employer immediately for reimbursement.
Your Employer Submits a First Report of Injury (Form WC-1)
After receiving notification of your work-related injury or illness, your employer must report your condition immediately to their workers’ compensation insurance carrier by filling out the top portion of an SBWC Form WC-1.
By doing so, your employer notifies the insurer of your potential claim. In some cases, that notification is all that’s required for you to begin receiving workers’ compensation benefits. But there’s no guarantee.
The Workers’ Comp Insurance Company Investigates
Once the insurer receives the Form WC-1 from your employer, it opens an investigation into your injury or illness to determine if you have a covered claim for medical, disability, or other benefits. Your employer may participate in that investigation, too.
You must cooperate with any investigation by the insurer or your employer. If you don’t, you could lose your benefits. But your participation can also put you at risk. For example, an aggressive investigator might ask you loaded questions or demand unnecessary access to your medical history. That’s why, as discussed below, it’s helpful to have an attorney represent you throughout the workers’ comp claim process.
The Workers’ Comp Insurance Company Issues a Claim Decision
No later than 21 days after your first report of an injury or illness to your employer, the insurer must complete the investigation and notify you of its decision on whether to pay benefits.
It does so by completing one of the bottom sections of the Form WC-1 it received from your employer, filing it with the SBWC, and sending a copy to you and your attorney (if you have one).
The form will indicate that the insurer:
- Accepts your claim and will cover your medical care and pay disability benefits in a specified amount;
- Denies (or “controverts”) your claim and refuses to pay medical or disability benefits;
- Agrees to cover your medical care but not pay disability benefits.
If the carrier accepts your claim and agrees to pay full medical and disability benefits, that’s the end of the claim process. Your medical care is covered, and you should start receiving your disability payments within days.
But beware: sometimes, the carrier will accept the claim but award less disability or medical benefits than a claimant deserves. And, of course, workers’ comp carriers often deny claims in part or in full instead of accepting them.
To protect your rights and ensure fair treatment, consult an attorney immediately upon receiving a Form WC-1 from your employer’s workers’ comp insurance company, no matter what it says about the claim decision.
Contact a lawyer, too, if you receive a Form WC-2 (“Notice of Payment or Suspension of Benefits”) or WC-3 (“Notice to Controvert”) from the workers’ compensation insurer. These forms can also notify you of benefits decisions that impact your rights.
You File a Notice of Claim and/or Request for Hearing (Form WC-14)
The investigation and claim decision process described above should happen more or less automatically once you’ve notified your employer of your work-related health condition and sought medical care. But Georgia law also gives you the right to notify the SBWC directly about your injury or illness and to request its involvement in your claim by filling out and submitting Form WC-14.
Filing a Form WC-14 can serve three purposes:
- It can notify the SBWC of your potential claim for workers’ comp benefits when your employer has failed to do so;
- It can request an administrative hearing (similar to a court trial) before the SBWC to contest a partial or total denial of your claim; or
- It can request the SBWC’s assistance in mediating a contested claim.
Confusingly, many websites (including the official site for the SBWC) refer to submitting a Form WC-14 to the state as “filing a claim.” Some even say you must file a Form WC-14 to begin the workers’ comp claim process.
Workers in Georgia rarely have to do anything to initiate a claim other than notify their employer and seek medical care since most employers fill out a Form WC-1 and send it to the workers’ comp insurer as described above.
In other words, you do have to file a Form WC-14 to start the claim process if your employer has already submitted a Form WC-1 to the workers’ comp insurance company.
But you may have other reasons to file a Form WC-14. Most commonly, workers file a Form WC-14 with the state when they want to dispute an adverse workers’ comp claim decision. Filing the form involves the SBWC resolving a disputed claim through a hearing or mediation. The deadline for filing Form WC-14 is one year from the date of the injury.
Why You Need a Workers’ Compensation Claim Lawyer?
Every step in claiming workers’ comp benefits in Georgia hides pitfalls for injured and sick workers. Mistakes you make in giving written notice to your employer, participating in an investigation, evaluating whether a claim decision is fair, deciding whether and when to submit a Form WC-14, or participating in proceedings before the SBWC, can impair your rights and leave you with fewer benefits than you deserve, or no benefits at all.
A skilled workers’ comp lawyer can handle your claim from the get-go, serving as your representative, advocate, and ally. A lawyer can prepare and review paperwork, independently evaluate the benefits you should receive, and take all necessary steps to contest an unfair claim decision. A lawyer may even get you extra compensation by pursuing a lawsuit against a third party on your behalf.
Hiring a lawyer for your workers’ comp claim is affordable. Workers’ comp attorneys represent their clients on contingency, which means they only get paid if they deliver results. You’ll never pay a dime upfront or as your case progresses.
Contact an Experienced Georgia Workers’ Compensation Lawyer Today
If you or a loved one recently sustained injuries or fell ill in connection with doing your job in Georgia, you may have the right to receive significant workers’ compensation benefits and other payments. Hiring a lawyer is the most reliable way to ensure you get fair treatment and the money you deserve. Contact an experienced personal injury attorney in Augusta today for a free consultation.