Georgia Workers Compensation Claims: Eligibility, Filing and Appeals

Worker’s compensation coverage is expansive in Georgia and nearly all workers are covered. Coverage extends to volunteer firefighters, EMTs, and rescue workers. Agricultural workers, common carriers on railroads or who work in interstate commerce, and independent contractors are exempt from coverage. Corporate officers, and partners can request to be exempt from coverage.

Employers and employees can opt out of workers compensation by agreement if the employer provides another protection system in which the benefits are at least equal to those provided by workers compensation, and the substitute system requires no additional employee contribution to achieve those benefits. The Workers Compensation Board must approve substitute systems of workers compensation, according to O.C.G.A. section 34-9-14.

Common Covered Work Related Injuries

Georgia workers compensation coverage extends to injuries or personal injuries that arise “out of and in the course of the employment.” Diseases are not included unless they result naturally from an accident or are inherently related to the work environment. Aggravations of pre-existing conditions can constitute an injury if the aggravation is causing the disability. 

Willful acts by third parties for personal reasons are not covered. Coverage is not provided for injuries sustained while intoxicated at work. Heart conditions and/or heart disease are not covered unless a preponderance of the evidence shows that the condition arose out of the usual course of employment.

How to file a Georgia Workers Compensation Claim

Workers must report all injuries to their employer by notifying a supervisor, boss, foreman, or agent of the employer. If possible, the accident should be reported in writing. The accident must be reported in writing within 30 days of the injury in order to remain eligible for benefits. The employer must provide forms as required by law for filing a worker’s compensation claim.

The employer upon receiving notice of an injury must fill out form WC-1, the Employers First Report of Injury. This form is then submitted to the insurance carrier who must forward a copy to the Worker’s Compensation Board.

Workers Compensation Claim Denials

Common reasons for denial include disputes that the injury arose out of or in the context of employment, and insufficient notice provided to employers within the required period of time.

Appealing a Georgia Workers Compensation Denial

When a claim is denied, you must request a mediation conference or hearing using Form WC-14. This form is available from your employer or the Worker’s Compensation board and must be submitted directly to the workers compensation board. A request for a hearing is not appropriate until the maximum time available for the employer to make the first payment has expired (21 days from the date the employer has knowledge of injury).  The hearing will usually be scheduled within 60 days of the date the board receives your request for a hearing.

An appellate administrative law judge from the Worker’s Compensation Board is assigned to hear the case and to make a final determination. Evidence, expert testimony and witnesses may be presented.

Collecting Georgia Workers Compensation Benefits

Benefits include medical treatment, temporary and permanent disability, and death benefits. In order for medical care to be covered, you must see a doctor on a panel of physicians approved by your employer’s insurance carrier. This panel must contain at least six doctors and you may choose any of the six physicians. You may also be required to get approval from the Workers Compensation Managed Care Organization prior to receiving medical care in order to ensure the Benefits are covered.

Temporary disability is available if you are unable to work for seven or more days. Benefits are due no later then 21 days after the employer receives notice of the injury. Disability income payments are then paid every week thereafter unless the Workers’ Compensation Board and injured worker agree on another payment distribution schedule. Temporary disability benefits are paid at 2/3 of your average weekly wages up to a maximum of $450 per week. These benefits can be paid for up to 400 weeks.

If you sustain a permanent disability that precludes you from working full time, you may receive a permanent partial disability benefit up to $300. If you sustain a catastrophic industry that prevents you from ever returning to work, you may be entitled to lifetime benefits and/or job retraining. Your lifetime weekly benefit payment is determined based on your disability rating and your average weekly wages. Additional benefits are paid if you lose a limb or lose your vision or hearing.

Hiring a Georgia Workers Compensation Lawyer

Although you are permitted to represent yourself in a worker’s compensation hearing, it may be advisable to hire an attorney to assist you in proving your claim for disability and providing the required information. An attorney can also help to ensure that you satisfy all notice requirements and provide proper supporting documentation to minimize the chances that your claim will be denied.

Georgia Workers Compensation Office Locations

270 Peachtree Street, N.W.

Suite 400

Atlanta, GA 30303-1299

Phone: (404) 656-3875

1-800-533-0682

www.sbwc.georgia.gov

Suite 203, Albany Towers

235 Roosevelt Avenue  P.O. Box 1649

Albany, GA 31701 Albany  

Phone: (229) 430-4280

1056 Claussen Road Suite 224

Augusta, GA 30907

Phone: (706) 667-4062

Heritage Tower, Suite 200

18 9th Street

Columbus, GA 31901  

Phone: (706) 649-1103

6253 Highway 278, N.E.

Fred’s Plaza

Covington, GA 30014

Phone: (770) 784-3133

415 East Walnut Avenue

Dalton, GA 30721-4406

Phone: (706) 272-2284

311 Green Street, N.W.

Gainesville, GA 30501-3366

Phone: (770) 535-5713

110 Holiday Drive, N.

Suite A

Macon, GA 31210-1802

Phone: (478) 471-2051

512 Riverside Parkway, Ste 400

Rome, GA 30161-3128

Phone: (706) 295-6781

7 East Congress St.

Savannah, GA 31401

Phone: (912) 651-6222