By GNGF Design/Development on September 27th, 2024 in Uncategorized
Workers’ compensation is available to most workers of companies with three or more employees. If your employer does have workers’ comp insurance, you have a right to file a claim for benefits if you’re injured on the job.
However, as with most types of insurance, there are exceptions, or in this case disqualifications, which may render you ineligible for benefits.
Not sure if you qualify for benefits?
Contact us, and we’ll discuss your claim with you further.
What Disqualifies a Person from Workers Comp Benefits?
If you’re injured on the job and your employer has insurance, you should be eligible for benefits. Requirements must be met before benefits are paid out, but there are also factors that can disqualify you from receiving benefits, such as:
Injuring Yourself Intentionally
Insurance companies know that some workers may injure themselves to receive benefits. You might purposely trip and fall, allowing you to file a claim and then collect benefits while you recover.
Much in the same way that people make false claims to a car insurance company, the same occurs with workers’ comp.
If your injuries are self-inflicted, there’s a good chance that your benefits will be denied. Self-infliction does not mean accidental injuries. Your deliberate action must be to harm yourself.
For example:
- If you purposely hit your hand with a hammer to break it and collect benefits, you will be disqualified from benefits.
- If you tripped over a box unintentionally, your claim is likely to be approved because you didn’t try to inflict harm upon yourself.
You can also deliberately ignore safety protocols, which would make you responsible for your injuries.
Deliberately Ignoring or Refusing to Follow Safety Protocols
Workplace policies are in place to protect you – the worker. Safety protocols may also be in place for this very reason. If you don’t follow protocols, you may be ineligible for benefits. For example, if you’re a construction worker and are required to wear a safety harness but do not, resulting in injuries, you may be disqualified from receiving benefits.
A harness may have prevented your fall, resulting in no injuries if you wore one.
Now, if the harness fails and you fall, you’re still eligible for benefits because you followed safety protocols to the best of your ability.
You’re an Independent Contractor, Not an Employee
If you are an independent contractor, as is allowed in Georgia, you’re ineligible for benefits. Employers need to classify workers properly for this rule to apply. If you’re treated as an employee rather than a contractor and are misclassified, you may be eligible for benefits if your lawyer can prove your employer was trying to avoid providing benefits to you.
Your Injuries Were Outside of the Scope of Employment
Workers’ compensation benefits are only available to workers who are injured while on the job and performing tasks within the scope of their employment.
If you were injured in an accident on your way to work or while in the workplace after-hours, you may not qualify for benefits.
You Were Under the Influence When the Accident Occurred
If you were injured in an accident at work while voluntarily intoxicated or even under the influence of prescription drugs, you may be disqualified from workers’ compensation.
You may be asked to take a drug test if your employer suspects that your injury was caused by your intoxication. If you refuse the drug test or take it and fail it, the state may deny your benefits.
You Missed the Deadline for Filing a Claim or Reporting the Injury
Many injured workers are denied workers’ comp benefits because they fail to report the injury in a timely manner or file a claim before the deadline.
In Georgia, you have:
- 30 days to notify your employer of your injury
- One year from the date of your reported injury to file a workers’ compensation claim
There are exceptions to these rules, but generally, if you miss either of these deadlines, your workers’ comp benefits may be denied.
What Do I Do in Case of a Denial?
If your workers’ compensation claim was denied, do not give up hope. When claims are rejected, Georgia workers generally have the option to appeal the decision through:
- An internal administrative appeals process with the insurance company, or
- By filing a formal claim with the Georgia State Board of Workers’ Compensation to request a hearing
Hearings are similar to a trial in that both sides (you and your employer) will go through the process of discovery. You may be asked to provide testimony in a deposition or undergo an independent medical exam.
Formal hearings are held in front of an administrative judge. Both sides will present evidence or testimony to prove their case. The judge will then come to a decision on the matter.
That decision can also be appealed to the state board’s appellate division.
The appeals process is complex. To achieve the best possible outcome, you need the help and expertise of an experienced workers’ compensation attorney.
You don’t have to go through the appeals process alone. The attorneys at The Law Offices of Darwin F. Johnson can help you navigate every step and fight for the benefits you deserve.
Contact us or call us to schedule a consultation and discuss your claim.
