Unfortunately, workers’ compensation insurers dispute claims filed by Alpharetta workers on a somewhat regular basis. Despite the fact that Georgia has established a “no-fault” workers’ compensation scheme, which means employees do not have to prove any negligence or wrongdoing on the part of the employer that contributed to their injury, injured employees are still denied benefits far too often.
Fortunately, workers are frequently able to receive benefits after appealing a workers’ compensation decision in Alpharetta. In many cases, injured employees work with a local workers’ compensation attorney to ensure that requirements are met and substantiated by persuasive evidence, and so they have a strong advocate on their behalf during the appeals process.
In the first part of a workers’ compensation claim in Georgia, the employee reports the injury suffered on the job or the diagnosis of an occupational disease to the employer. They must also file a Notice of Claim form (WC-14) with the State Board of Workers’ Compensation and undergo a medical exam by a doctor or managed care organization approved by the employer.
The employee must file copies of this claim form with both the employer and the workers’ compensation insurance company. Following this, the insurer investigates the claim to assess whether the employee should be entitled to workers’ compensation medical benefits, income benefits, or other benefits. If the insurer disputes the claim, the case may be appealed.
The first avenue of appeal when a workers’ compensation claim is disputed is to seek a hearing before a State Board of Workers’ Compensation administrative judge. Most often, the administrative hearing is held in the county where the workplace injury occurred. While such hearings are supposed to take place within a 60-day window of time, in many cases they are postponed.
Evidence presented at this hearing is extremely important, because any further appeals would be based on the factual determinations made during this hearing. Both the employee and the employer have the opportunity in this hearing to present factual evidence regarding the circumstances and severity of the injury.
Employees are not required to have an attorney represent them at the hearing, but because of the formal trial procedures which must be followed, the State of Georgia advises claimants to take caution when representing their own interests without legal assistance. Since workers’ compensation insurers often make use of experienced defense attorneys, it is often wise for an employee to have a knowledgeable legal adviser to advocate on their behalf.
In cases where an administrative trial judge rules against the employee, the worker may appeal the decision to the Appellate Division of the State Board of Workers’ Compensation. At this level and for any subsequent appeals, arguments generally must be based on a challenge of legal determinations or procedural issues rather than findings of fact which are considered settled at the hearing. An unfavorable decision by the Appellate Division may be appealed to the Georgia Superior Court, and beyond that to the Georgia Court of Appeals.
The workers’ compensation scheme that was intended to enable employees to recover and get back to work quickly without the delay of a lawsuit has become so contentious and complex that is it now similar in many respects to filing a traditional lawsuit. Because it is so important to follow procedures and establish credible evidence throughout the process, many employees find it valuable to use the services of an experienced attorney when appealing a workers’ compensation decision in Alpharetta. To learn how a seasoned workers’ comp attorney can help with an appeal, call for a free consultation.
With offices in Alpharetta, Atlanta and Marietta, we provide legal assistance to people throughout Georgia and the Southeast in all matters of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), and workers’ compensation claims.
We are ready to help you, and offer multiple ways to reach us.