Oct 30, 2023

What Disqualifies Someone from Workers’ Comp Benefits?

Workers’ compensation is a vital safety net for employees who suffer injuries or illnesses on the job. In Georgia, workers’ compensation laws protect the rights of workers and employers. However, not every workplace injury or illness automatically qualifies an employee for workers’ compensation benefits. There are certain conditions and circumstances that may disqualify someone from receiving these benefits.

Hand Wrapped In Bandages

Failure to Report the Injury On Time Can Make You Ineligible to Claim Compensation

One of the key disqualifying factors in Georgia’s workers’ compensation system is the failure to report a workplace injury or illness promptly. Timely reporting is important as it ensures that employers are made aware of the incident promptly, enabling them to investigate the circumstances and make the necessary arrangements for medical treatment and workers’ compensation benefits.

Under O.C.G.A. § 34-9-80, injured workers are legally obligated to notify their employer within 30 days of the injury or, in the case of occupational diseases, within 30 days of the date they became aware of the condition’s work-related nature. Failing to report the injury within this statutory timeframe can lead to disqualification from workers’ compensation benefits.

Notably, there are some exceptions to this rule. For example, if an employee can show a reasonable excuse for not reporting the injury within the specified timeframe, such as being physically or mentally unable to do so, the reporting requirement may be waived.

Other Disqualifications in Georgia Workers’ Compensation

Intentional Self-Injury

Workers’ compensation is not designed to cover injuries that are intentionally self-inflicted. If it is found that the injury resulted from an employee’s deliberate action to harm themselves, benefits can be denied.

Injuries Outside the Scope of Employment

Georgia’s workers’ compensation system covers injuries and illnesses that occur within the scope of employment. If an injury happens outside the workplace or while the employee is engaged in personal activities, it may not qualify for benefits.

Violations of Workplace Policies

If an employee was injured while violating company policies, engaging in horseplay, or being under the influence of alcohol or drugs at the time of the incident, their claim may be denied. Employers often have written policies detailing safety procedures, and failure to follow these policies can disqualify an employee from benefits.

Independent Contractor Status

Some workers in Georgia may be classified as independent contractors rather than employees. Independent contractors are generally not eligible for workers’ compensation benefits. However, it is essential to ensure the classification is accurate, as some employers may misclassify workers to avoid providing benefits.

Failure to Seek Medical Treatment

O.C.G.A. § 34-9-200 requires injured employees to seek medical treatment from a physician selected by the employer or the employer’s workers’ compensation insurance carrier. Failure to do so can lead to disqualification from benefits.

Pre-Existing Conditions

If an employee’s injury aggravates a pre-existing condition, determining the extent of the aggravation can be challenging. In some cases, benefits may be reduced to account for the pre-existing condition’s contribution to the injury.

Lack of Employment Relationship

To qualify for workers’ compensation, there must be an employment relationship between the injured party and the employer. Independent contractors, volunteers, and some other individuals may not meet this criteria and, therefore, be disqualified from benefits.

Fraudulent Claims

Making a fraudulent workers’ compensation claim, such as exaggerating the extent of injuries or misrepresenting the cause of the injury, can result in benefits being denied, and legal consequences may follow.

Will Going Back to Work Make Me Ineligible to Claim Workers’ Compensation in Georgia?

Returning to work after a workplace injury in Georgia does not necessarily make you ineligible to claim workers’ compensation benefits. However, it can have implications for your claim, depending on the circumstances. Here are some key considerations:

  • Temporary Partial Disability (TPD): If you are able to return to work in a limited capacity and are earning less due to your injury, you may be eligible for Temporary Partial Disability benefits.
  • Medical Treatment: Regardless of your ability to work, workers’ compensation in Georgia typically covers the cost of necessary medical treatment related to your workplace injury.
  • Medical Clearance: Your ability to return to work may also depend on whether you have received medical clearance from your treating physician.

Legal Counsel and Appeals

When facing disqualification from workers’ compensation benefits, employees have the right to appeal this decision. The Georgia State Board of Workers’ Compensation handles disputes related to workers’ compensation claims. Through a form WC-14, workers can request a hearing before an Administrative Law Judge. Make sure you consult with a proven and capable Atlanta worker’s comp attorney experienced in workers’ compensation law during this process.

Person Filling Out An Injury Compensation Claim Document On A Laptop

How Our Atlanta Workers’ Compensation Lawyers Can Help Ensure Your Claim is Not Denied or Diminished

If you have suffered a workplace injury, you need to ensure that your workers’ compensation claim is not denied or diminished. At Hansford McDaniel – Workers’ Compensation Attorneys, we understand the challenges you face. Our Atlanta workers’ comp attorneys will relentlessly advocate for your best interests and obtain the maximum compensation you deserve.

We Thoroughly Gather and Review Evidence

A successful workers’ compensation claim hinges on having a strong case supported by evidence. Our workers’ comp attorney team works with you to gather all necessary documentation, including medical records, incident reports, and witness statements. We leave no stone unturned in collecting the evidence needed to demonstrate the validity of your claim and the extent of your injuries.

We Guide You Through the Complex Legal Process

Navigating the workers’ compensation process can be overwhelming, with numerous deadlines and legal requirements. Our experienced workers’ compensation lawyer team is well-versed in Georgia’s workers’ compensation laws, including the relevant statutes and regulations. We provide you with expert guidance and support at every step, ensuring that you meet all the necessary legal obligations and submit your claim within the required timeframes.

We Strongly Represent You in Disputes and Appeals

If your workers’ compensation claim is denied, we have the knowledge and experience to handle disputes and appeals effectively. Our team will represent your interests before the Georgia State Board of Workers’ Compensation and work diligently to have your claim approved. This involves presenting compelling evidence, making persuasive legal arguments, and negotiating with insurance companies to fight the claim denied and secure the benefits you deserve.

We Work to Maximize Your Benefits

Our ultimate goal is to help you receive the full extent of the benefits you are entitled to under the law. Whether the workers’ comp claims benefits are for medical expenses, lost wages, disability compensation, or vocational rehabilitation, we will strongly negotiate with the workers’ comp insurance company and your employer to ensure you receive the maximum compensation you are entitled to under the law.

Choose a Dedicated Atlanta Law Firm for Your Workers’ Comp Claim

If you or someone you love has suffered a work-related injury in Atlanta, you have a right to seek maximum compensation available under Georgia laws. At Hansford McDaniel – Workers’ Compensation Attorneys, our proven and capable Atlanta workers’ compensation lawyers are ready to champion your rights. With nearly half a century of collective experience, our legal team is committed to achieving the largest possible workers’ compensation benefits for every injured worker we represent. Schedule your free consultation with our Georgia workers’ compensation claim attorneys today. Call us now at 770-922-3660 or contact us online.