Filing for Workers’ Comp: 4 Important Steps

Workers' compensation complaint form

Atlanta workers’ comp lawyers can help you navigate your claim when injured on the job, when you contract a workplace illness, suffer a repetitive trauma injury, or when a chronic disability is worsened by workplace demands.

What Is Workers’ Compensation? Workers’ Compensation is a state medical and disability benefits program provided to workers who are injured on the job or who develop an occupational disease as a result of their job.

For those employed in Atlanta, for example, the program is run by the Georgia State Board of Workers’ Compensation.

To qualify, you must be employed by a company required to have workers’ compensation insurance. Independent contractors, consultants, and freelancers don’t qualify.

Depending on the nature of your claim, you may receive short-term benefits, those for a long-term or permanent disability, or in some cases even death benefits for surviving loved ones.

Do You Qualify for Workers’ Comp? Essentially, you qualify if you meet the conditions above and can prove your condition was caused by the work environment, which OSHA defines as: “the establishment and other locations where one or more employees are working or are present as a condition of their employment. The work environment includes not only physical locations, but also the equipment or materials used by the employee during the course of his or her work.”

In other words, the cause of your claim doesn’t have to occur in your office building, so long as it meets OSHA’s definition.

Unlike some other types of benefits programs, which may require you to medically prove a disability by strict parameters, worker’s compensation covers a wide range of injuries and conditions that are caused by the workplace.

Now that you know what worker’s compensation is and what qualifies as work-related, there are certain steps you should follow when filing a claim. Here are four main steps to keep in mind.

1. Tell Your Boss When You Need to File a Workers’ Compensation Claim

In the state of Georgia, you must tell a supervisor about any incident you’re going to file a claim for within 30 days. You should do this both verbally and in writing.

Regardless, it’s always a good idea to err on the side of caution and initiate a claim even if you think you may not be that badly hurt. You never know if symptoms may worsen or what may qualify you for benefits.

At this point, the employer should file a claim for the company and provide you with certain information. You would also file a claim, filling out the Notice of Claim, form WC-14.

Your boss cannot discriminate against you or otherwise prevent or discourage you from filing a workers’ comp claim, and they must reasonably accommodate any modifications to your work environment you may medically need due to your condition, according to your doctor’s recommendations.

2. Seeking Medical Treatment

Being evaluated and treated by a doctor is one of the most crucial steps when filing a claim. You’re required to see an approved workers’ compensation physician, who will make a determination that either you may perform restricted work or that you cannot work.

Note: The workers’ compensation insurer should cover:

  •       all authorized bills from your doctor
  •       hospital bills
  •       physical therapy
  •       pharmacy costs
  •       necessary travel expenses
  •       approved medical and vocational rehabilitation

Seeking medical treatment is important not only to aid with your condition but also to potentially qualify you for weekly wage loss payments.

In Georgia, these payments are “two-thirds of your average weekly wage, but not more than $675.00 per week for an accident which occurred on or after July 1, 2019,” according to the State Board of Workers’ Compensation.

3. Do You Want a Claim Settlement?

If you’ve won your claim, including past medical costs, lost wages, and future earnings, you may want to settle your workers’ compensation claim.

Basically, you’re encouraged to seek a settlement agreement for future earnings with the insurance company. This can be structured in one of two ways:

  1.     A lump-sum settlement. The claimant agrees to give up certain rights in exchange for a one-time payment from your employer or their insurance company.
  2.     A structured settlement. A long-term payout of benefits through an annuity.

A claim settlement will be calculated based on whether you have a total or partial disability, or have no lasting damage. As each case is unique, it’s important to discuss a settlement with your attorney.

4. Appealing a Denial—and Other Reasons to Consult an Attorney

If you feel your claim is unfairly denied, you can appeal the decision and request a hearing. There are several levels of appeal for workers’ compensation cases, including:

  •       a hearing before an administrative law judge
  •       the Appellate Division of the Georgia State Board
  •       the Superior Court in the county where the injury happened

Each of these levels of appeal can be daunting, and a knowledgeable workers’ comp attorney can help you navigate them. During a hearing, your attorney can make legal opening remarks, question you as the claimant, respond to inquiries from the judge, and also cross-examine the vocational expert in your hearing. They’ll also help you prepare for what to expect at the hearing, as well as completing any pre-hearing steps such as filing medical reports and statements.

In addition to the appeals process, you may need an attorney if:

  • you need consultation on how to negotiate a lump sum or structured settlement
  • you anticipate a lawyer can help maximize your potential benefits
  •       the insurance company doesn’t authorize medical treatment or send weekly checks on time
  • your injury prevents you from returning to the job you worked before
  • you feel mistreated by the insurance company or your employer
  • your employer has fired you

Attorneys can help you evaluate your claim, organize the most important facts of your medical history, and help you present a strong, compelling case that can lead to a successful settlement.

An initial consultation with Affleck & Gordon is free.

If your workers comp claim has been denied, or you’re thinking about filing and don’t know where to start, Affleck and Gordon can help. We’ve been helping people in Georgia just like you for over 45 years.

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