This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
To file a claim you must complete a WC-14 with the State Board of Workers Compensation and send a copy to the form to your employer and the workers’ compensation insurance carrier.
If your injury requires you seek medical attention, consult the information provided by your employer about appropriate medical providers you may request care from. Your employer is required to post at least six (6) doctors or the name of the certified medical care provider you may consult. Your employer's workers' compensation insurance carrier will pay for your authorized medical treatment.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Your employer is required by law to purchase workers' compensation insurance if your employer employs three or more persons in a Georgia business, whether full-time or part-time employees. To determine whether your employer is participating in a coverage plan, you may visit the State Board of Workers' Compensation website to gain access to more information.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
If you are involved in an accident while on the job, your accident will be classified as either catastrophic or non-catastrophic. Catastrophic injuries are those involving amputations, severe paralysis, severe head injury, severe burns, blindness, or of a nature and severity that prevents you from working in your typical field of work or a large proportion of jobs available. If you suffer from a catastrophic injury, you are entitled to receive wage, medical, or vocational rehabilitation benefits.
All other kinds of injuries suffered as a result of a workplace accident, you are entitled to receive wage benefits for as long as you're disabled, but no longer than 400 weeks.
A compensable work-related claim must be one arising out of and in the course of your employment (i.e. while you are performing assigned duties during regular work hours). You will not be entitled to benefits if your injury is a result of your own willful misconduct, non-compliance with workplace rules and protocol, and/or a result of being under the influence of drugs or alcohol.
You may risk your entitlement for benefits by: failing to report your injuries promptly; failing to cooperate with your employer or authorized medical provider; refusing to return to suitable employment; working elsewhere while receiving disability benefits; submitting false information; refusing to take a drug test and/or other medical examinations reasonably required by the authorized medical care provider.
4. What benefits might I be eligible to receive?
Medical benefits covered by your employer's insurance provider may include authorized doctor bill, hospital bills, physical therapy, prescriptions, and necessary travel expenses.
You may also be entitled to weekly wage benefits if you are unable to work for more than seven days as a result of your workplace accident/injury. Your benefits will be calculated as two-thirds of your average weekly wage, but no more than $500.00 per week. You will receive these benefits for up to 400 weeks.
If you are able to return to work but are not able to work in the same capacity as prior to the injury, you may receive a reduced benefit to compensate your earnings for up to 350 weeks after the date of your injury. This benefit cannot exceed $334.00 per week.
If you are unable to return to work in the field you previously were employed as a result of your injury, you may receive aid in the form of vocational training or job assistance.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
You should report any accident you are involved with to your employer as soon as possible, but no later than thirty (30) days after the date of incident. From that point, your employer should contact your employer's insurance provider to make a determination about covering expenses and certain benefits related to your accident. If your employer or your employer's insurance provider deny your claim, you have one year from the time of your last authorized medical treatment or two (2) years from your last payment of weekly benefits to file a claim with the State Board of Workers' Compensation commission.
If your claim is denied, your employer and/or your employer's insurance provider will provide you notification for the reason of denial. If you are unsatisfied with the determination, you may request a hearing with the State Board of Workers' Compensation within one year of the date of your injury.
6. If I am not happy with the determination, how do I appeal?
Your claim is considered open until all benefits are paid or once you, your employer, and/or your employer's insurance provider agree upon a settlement.
If you remain dissatisfied with the determination of the State Workers' Compensation Board, you may appeal to the Georgia courts to review your claim. Georgia law and the respective court rules of the court to which you appeal will govern your appeal.