An employer/insurer has a twenty-one day grace period from the date of the injury to investigate the accident before either providing benefits or filing a denial of your claim. Unfortunately, it is common for claims to be ignored by the employer/insurer even though you provided timely notice of when you were hurt on the job. The employer/insurer might provide only limited medical treatment or no treatment at all. Despite missing time from work because of your injury, the employer/insurer may refuse to send weekly income benefit checks. Other times, without explanation, the employer/insurer might deny the claim outright.
If this occurs, you must file a formal claim with the State Board of Workers’ Compensation in order to protect your rights. You have one year from the date of injury in which to file the formal claim with the State Board. The one year statute of limitation can be extended if the employer/insurer provided medical treatment, but the form must be filed with the State Board within one year of your last receipt of employer-funded medical treatment. However, it is very important to understand that if no income benefits are paid nor medical benefits provided, your claim will be forever barred if the formal notice is not filed in a timely manner.
In some claims, medical and income benefits are initially provided, but are then suspended based upon a return to work, an offer of suitable employment, or a full-duty release from the treating physician. If you believe your benefits have been wrongly suspended, the only way to protect your rights is to file a formal claim with the State Board. Once the claim is filed, you will then have the right to present evidence to an administrative law judge seeking an order for the recommencement of your benefits. The Trial Division of the State Board of Workers’ Compensation sets hearings before administrative law judges in the county or contingent county where the injury occurred. Hearings are typically held 60 to 90 days after the notice is filed.
After the hearing with the administrative law judge, there is a four step appeals process. Within 20 days of the administrative law judge’s award, either side can file an appeal to the Appellate Division of the State Board. This process usually takes two to three months. The State Board will either affirm or reverse the administrative law judge’s finding. The next level of appeal is to the Superior Court in the county where the injury occurred. Attorneys for each side will present arguments. The Superior Court is legally bound to affirm the State Board’s award if there is no legal error or if there is any evidence supporting the findings. After that, either side may take the claim to the Georgia Court of Appeals, but they must apply to be heard.
This is why we strongly urge you to contact us if you have been hurt on the job – we’ll walk you through the process and answer all of your questions. It can be a confusing process, but with our 50+ years of workers compensation experience, we’ve helped many workers hurt on the job get everything they deserve.