What to Do If Your Employer Resists a Workers’ Comp Claim?
You’ve been hurt at work and now your employer resists a workers’ comp claim?
This happens again and again.
Employers often deny workers’ comp claims. Insurance companies deny them even more.
For example, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) reports 3,831 workers’ compensation claims in Georgia in 2001. Of those, 2,029 were denied and 1,802 were approved.
More claims were denied than approved.
You may hear that and feel like giving up – especially if your employer resists a workers’ comp claim.
Don’t give up!
Lockton Analytics reports, “While some of these denials are sustained and do not pay out, Lockton Analytics found that on average, 67 percent of initial denials convert to paid claims by 12 months. Think about that for a minute: on average, more than two out of three denied claims will pay out!”
There is hope.
Ultimately, if you were injured at work, you should receive workers’ compensation benefits – even if you are at fault.
It just may take some time (and a fight from your attorney) to get the workers’ compensation benefits you deserve.
Let me explain how the process is supposed to work and what to do if your employer resists a workers’ comp claim.
The Role of the Employer in Workers’ Comp
Under Georgia workers’ comp law, any business with three or more workers, including regular part-time workers, is required to have workers’ compensation insurance.
You can verify your employer’s coverage at www.sbwc.georgia.gov.
Workers’ compensation ensures employees can secure benefits and lost wages benefits if injured on the job, according to Georgia workers’ comp law.
But many people don’t realize that the Georgia workers’ compensation law was designed to protect the employer, too.
If employers carry workers’ compensation insurance, the employer(s) won’t be held financially responsible for the associated cost when an employee is injured on the job.
Imagine, if every time an employee got hurt on the job, the employer had to pay for all the associated costs. Employers would quickly go out of business!
To avoid a bunch of bankrupt businesses, workers’ compensation insurance is designed to fill this gap.
However, it places some responsibility on the employer.
First, the employer must have workers’ compensation insurance if there are three or more employees.
Second, the employer must post a panel of physicians that work with their workers’ compensation insurance where employees can see it.
Next, your employer is legally required to file a “first report of injury” with the Georgia State Board of Workers’ Compensation.
This report should be filed promptly, enabling the injured employee to receive workers’ compensation benefits as soon as possible.
If the employer does not file this report (Form WC-1) with the insurer, there are penalties.
The Role of the Employee in Workers’ Comp
It’s important to understand that the employer cannot file the “first report of injury” unless they are aware of an injury.
It is up to YOU (the employee) to make it crystal clear that you have been injured at work, during work hours, and need medical attention.
You can’t simply say, “I need to go to the doctor.”
You must say, “I need to go to the emergency room and get treated because I fell from the loading dock while on my shift, and now I can’t walk without limping.”
You need to be that specific.
When should you do this? Immediately.
Check Out This Video: What Are the Magic Words?
As soon as you know you are hurt, and it happened at work, you should start the ball rolling.
This is because, under Georgia workers’ compensation law, you have a limited amount of time (only 30 days) to report the injury.
If you wait more than a month to report it to your employer, your employer and/or the insurance company can deny your workers’ compensation benefits.
Reasons Employers Resist Workers’ Comp Claims
Even though workers’ compensation law is designed to help both the employee and the employer, there are some employers who are not fans of it.
One reason is that it takes up their time. They have to fill out paperwork and deal with the insurance company.
Another reason is that they don’t want to lose out on an employee.
If you are hurt and the attending physician says you are unable to work, your employer is out an employee until you are well enough to return to work.
Those are reasons employers don’t like workers’ compensation, but there are other reasons why employers resist a workers’ comp claim.
The most common reason employers will resist a claim is because they do not believe the injury actually happened at work.
This is one of the dangers of not reporting an injury immediately.
Let’s say you fell at work on a Friday and didn’t realize you sprained your ankle until Saturday.
When you return to work on Monday and tell your boss, they may think you actually hurt yourself over the weekend and are lying to receive workers’ compensation.
Another reason an employer resists a workers’ comp claim is that they don’t think you are really “that” hurt.
If the employer can’t see a physical injury, he may think you are exaggerating your pain or lying.
Another reason an employer may resist a workers’ comp claim is because they believe the injury occurred due to misconduct, such as being under the influence of alcohol or drugs.
Lastly, the more claims an employer has, the more their insurance premiums will go up.
Steps to Take If Your Employer Resists Your Workers’ Comp Claim
No matter what reason your employer gives for resisting your workers’ compensation claim, you still have a right to file a notice of claim with the Georgia State Board of Workers’ Compensation.
According to the Georgia State Board of Workers’ Compensation, “You need to complete and file a WC-14, with the State Board of Workers’ Compensation and send a copy of the form to your employer and their workers’ compensation insurance carrier.”
Filing a claim is different from reporting your injury.
You only have 30 days to report an injury, but you have one year from the date of your injury to file a claim.
If your employer still resists your workers’ compensation claim, you will need to prepare for a hearing in front of the State Board.
During this hearing, you will tell a judge why you are entitled to receive workers’ compensation benefits and present your evidence.
Your employer and the insurance company will then present the judge with their reasons for denying your claim.
The judge will then make a decision.
If the judge from the workers’ compensation hearing denies your claim, you may then file an additional appeal with the State Board’s Appellate Division.
The Simple Truth – You Need a Workers’ Comp Attorney
If you have been injured on the job and your employer resists a workers’ comp claim, you need to contact a workers’ comp attorney right away.
This is a clear sign your employer is going to make receiving your workers’ compensation benefits difficult, and you need a skilled attorney to fight on your behalf.
You will likely end up having to present your case in front of a judge. You don’t want to go to court without an attorney. Period.
Workers’ compensation attorneys have experience dealing with denied claims and resisting employers.
See More: 12 Ways a Workers’ Comp Lawyer Will Alleviate the Stress
If you’ve been injured on the job, contact us today for a free, no-strings-attached consultation.
Book Your Free Consult