After you get hurt at work, you probably expect the workers compensation insurance company to pay for the medical treatment you need to get better. You also expect them to pay you lost wages if your injury keeps you from working.
That is the way workers compensation is supposed to work. It was set up to function as a no-fault system. The idea was that you would be covered for your medical bills for your injury and a percent of your lost wages when you got hurt at work.
Unfortunately, the workers compensation system often does not work that way. Here are a list of some of the common problems people face:
- Instead of receiving the medical treatment you need quickly, you find that the insurance company delays or denies your medical treatment
- You do not receive your wage loss checks on time, or the insurance company stops your checks when they should not.
- The insurance company disputes all or part of your injury
All of these tactics and others are ways that the insurance company denies your benefits.
Can you fight the insurance company denials and win workers compensation benefits?
Yes. You can fight any type of workers compensation denial by the insurance company. In order to successfully defeat a denial, you need to know the method of attacking the denial and what evidence you need to overcome the denial.
In many instances, there is more than one way to fight a particular type of workers compensation denial. Some ways require different type of evidence . Some ways are faster than others. In situations where there is more than one way to fight a denial, you or an attorney you hire to represent you will need to fully understand the different methods and decide which one works best for your specific needs.
Can I go to court to win workers compensation benefits?
Yes. You can request a hearing and go to workers compensation court. This is one of the most common ways to attack a denial and try to win workers compensation benefits.
There are several things that are important to understand about court hearings in Georgia workers compensation cases. First, it is important to understand that it takes time to get to court and have a hearing in front of a judge. The first hearing date that you get from the Georgia State Board of Workers’ Compensation often will not happen because the hearing date will get rescheduled or postponed. It is not unusual for it to take six months or longer from when you request a hearing until when your hearing actually takes place.
It is also important to know that the workers compensation judge does not usually make a decision on the day of the hearing. In Georgia workers compensation cases, the judge usually makes the decision between 30 and 60 days after the hearing. Also, it is not uncommon for the judge’s decision to be appealed. If this happens, the benefits payable under the judge’s award may not have to be paid while the appeal is pending.
A third very important thing to understand is that there are rules that have to be followed to win your case in workers compensation court. To successfully prove your case, you or your attorney will need to understand the workers compensation laws that apply. Without understanding the law, you will not know what needs to be proven to a judge to win your case.
Also, workers compensation court has rules that control how evidence has to be presented. If the evidence is not presented in the right way, the judge will not consider it. If you do not present your evidence properly, you can lose your case even if you have the evidence you need to win it.
Is going to court the best way to win workers compensation benefits?
Not necessarily. The best way to win workers compensation benefits will depend on a number of factors including:
- What types of benefits you are trying to receive,
- How quickly you need to get these benefits, and
- What other methods are available to request the benefits you are seeking.
As discussed above, getting to court and getting a final decision from a judge takes a long time. In some situations, there are other methods of getting the workers compensation benefits you are seeking that take a lot less time.
One common example is denials of medical treatment requested by your authorized treating physician. In this situation, there are several methods of trying to get this treatment that may work much quicker than going to court about the benefits. A couple of them include:
- Contacting the insurance adjuster to convince them to agree to authorize the medical treatment
- Filing a Form WC-PMT and following the WC-PMT process
These methods generally work much quicker than going to court for getting an answer about medical treatment. But, there are also rules that apply with these two methods. While they can often be a better initial method to try than requesting a hearing, that is not always the case. The specific facts of your particular situation can affect which method is best to use for your case.
Is settlement a method of winning workers compensation benefits?
Yes. Settlement is one way of winning workers compensation benefits. In fact, settlement is the only way in a Georgia workers compensation case that you can receive a lump sum for the entire value of your workers compensation case.
This fact seems strange. But, Georgia law does not allow workers compensation judges to issue lump sum awards for your whole case. A workers compensation judge can only decide whatever issues are currently scheduled for a hearing.
As a method of getting benefits, settlement has its advantages and disadvantages. There are two very important things to know about settlement.
- Settlement requires agreement between you and the workers compensation insurance company
- Settlements are final so they almost always cannot be undone after a judge approves them
Often, settlement is worth considering as a method of winning workers compensation benefits. One advantage of settlement is that you can often use this method of winning workers compensation benefits at the same time as you are using other available methods. It is like working on a Plan A and a Plan B at the same time.
Here is an example to further explain that. Let’s say that you request a hearing about getting some workers compensation medical treatment approved. While you are going through the litigation process, you can negotiate with the insurance company about settlement at the same time.
While settlement can be a good option to explore, settlement is a very complicated process. Many people who do not fully understand it can end up making mistakes about when they settle their case and how much they settle it for.