What’s Not Covered by Workers’ Comp in Georgia?

If you’ve been injured on the job, you are likely wondering what’s not covered by workers’ comp in Georgia.

Let’s start with the good news. 

All businesses in Georgia with three or more employees are required to have workers’ compensation insurance, which means if you were injured at work, you are entitled to Georgia workers’ compensation benefits.

As an injured employee, you are entitled to compensation for:

  • Medical treatment
  • Rehabilitation
  • Medical supplies
  • Travel necessary for medical appointments
  • Income benefits and permanent disability

That is, unless your injury falls under a few categories. 

Ease your worries about what’s not covered by workers’ comp in Georgia by reviewing the list below.

What’s Not Covered by Workers’ Comp in Georgia

For the most part, what’s not covered by workers’ comp in Georgia is straightforward. 

Note – This doesn’t mean it is necessarily right, which is why it is important to hire a Georgia workers’ comp attorney to fight for you. Just because your injury may fall into one of the following categories doesn’t mean you are not entitled to Georgia workers’ comp benefits.

Click here to see what IS covered by workers’ comp in Georgia.

Pain and Suffering

Often, people mistakenly believe Georgia workers’ comp covers pain and suffering.

This is not the case. 

This is confusing workers’ compensation with personal injury claims.

When people talk about suing for pain and suffering, they tend to be discussing personal injury claims, such as car accidents.

However, workers’ compensation is not a lawsuit; it is a request for benefits.

A key difference between the two types of claims is that a personal injury claim requires you to prove your injury was the fault of someone else, but workers’ compensation does not require you to prove fault to receive benefits.

[Related Read: Can I Receive Workers’ Comp Benefits If I’m at Fault?]

Injuries That Occur outside of Work Hours

Georgia workers’ comp only covers injuries sustained while you are on the clock.

This means if you get in a car accident on your way to or from work, it is not covered by workers’ comp in Georgia. However, there can be some exceptions depending on the facts, so consult with a workers’ comp lawyer just in case. 

Or, if you suffer a slip and fall while on your lunch break, it is not covered. Again, there are exceptions to this as well, so consult with a worker’s comp lawyer. 

Unfortunately, this is how some insurance companies try to fight workers’ compensation claims. 

They will try to claim you were actually injured off the clock, so they don’t have to give you the money you deserve. 

This is another reason why it is wise to hire an experienced workers’ comp attorney.

Injuries While under the Influence

If your employer (or the medical professionals) believe your injury occurred while you were under the influence of alcohol or drugs, it will not be covered by Georgia workers’ compensation insurance.

Note – Your employer is allowed to require you to submit to a drug or alcohol screening following your injury. 

Let’s say you were not under the influence, but the test comes back positive due to a substance taken days before your injury. You need an attorney to fight for you.

Injuries Deemed the Result of Willful Misconduct

The Georgia State Board of Workers’ Compensation Employee Handbook states, “Workers’ compensation does not provide benefits for an injury or accident resulting from an employee’s willful misconduct (i.e., fighting, horseplay, willful act of third party for personal reasons, injuries related to alcohol or drug abuse).”

To put it plainly, if your injury occurred as an act of willful misconduct, such as roughhousing or blatantly disregarding the safety instructions, you may not be covered. Again, make sure you speak to a good workers’ comp attorney. 

Scars and Disfigurement

Unfortunately, Georgia workers’ comp does not provide permanent disability for scars or disfigurement that occur because of a work injury.

While the main injury that caused the scar or disfigurement is covered by workers’ compensation, the scars themselves typically do not result in permanent disability (PPD) money. 

Heart Attack and Strokes

If you are wondering about what’s not covered by workers’ comp in Georgia, you may be surprised to learn that heart attacks and strokes that occur on the clock may not be covered.

Since these medical events often occur inside and outside of work and happen due to many different medical conditions, they are often not covered by Georgia workers’ comp.

For example, for a heart attack or stroke to be covered by Georgia workers’ comp, it must be proven that the medical event started and happened while you were on the clock.

If you are considered high risk for either heart attacks or strokes (such as suffering from obesity or having a smoking habit), they can argue that this medical event is not work-related but due to your personal risk factors and could have occurred on or off the clock. Again, like so many of these topics, it is fact-intensive, so a good workers’ comp lawyer may be able to obtain benefits for you.

Psychological Trauma

While some states have started to include psychological trauma alone, such as PTSD, in workers’ compensation coverage, Georgia is not one of them.

If you experience psychological trauma as a result of a compensable physical bodily injury from a work accident, you can receive workers’ compensation benefits.

However, you cannot file a workers’ compensation claim in Georgia for psychological trauma alone (or without a physical injury).

A Note about Pre-Existing Conditions

There is often confusion regarding workers’ compensation coverage for pre-existing conditions.

You are eligible for Georgia workers’ compensation benefits if you aggravate or re-injure an existing condition at work.

However, insurance companies will often dispute the claim that you were injured at work if you have a pre-existing condition. 

Likewise, you must prove that you aggravated the injury AT work and not some other time or place.

This is another reason why hiring a workers’ compensation attorney is important.

Don’t Give Up! Hire a Georgia Workers’ Comp Attorney.

We’ve covered what’s not covered by workers’ comp in Georgia, but that doesn’t mean you should just give up.

The heat and physical exhaustion at the plant may have brought on a heart attack. The medication you take regularly may be flagged as the reason for your work injury when you know it isn’t. Your employer may argue the injury occurred off the clock.

The pain of your injury is enough to deal with without having to worry about proving how or why it happened.

This is why you should hire an experienced workers’ compensation attorney to help you navigate these challenges.

Not only will you need to prove the work injury occurred on the clock, but you also need to make sure your employer or the insurance company can’t argue it was due to any of the other reasons on this list. 

Watch Top 5 Questions to Ask a Workers’ Comp Lawyer

Video Here 

An attorney who has experience working with the Georgia State Board of Workers’ Compensation will know how to fight to get you the benefits you rightly deserve – even when the deck is stacked against you. 

Having an experienced workers’ compensation lawyer on your side not only makes the claim process easier but also ensures you get the best treatment possible so you can recover faster. 

If you’ve been told your injury doesn’t qualify for workers’ compensation, this is all the more reason to hire a lawyer for a workers’ comp claim.

If you’ve been injured on the job, contact us today for a free, no-strings-attached consultation.

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