How to receive compensation for work-related illness or disease
According to the U.S. Department of Labor, there were 7,332 workers’ compensation claims filed in Georgia in 2017. And not all of these claims were for physical injuries. Many types of jobs and occupations throughout the state have the potential of causing an employee work-related illness or injury. Aerospace, agriculture, construction and mining are just a few of the many professions where workers may come in contact with hazardous chemicals, dust, fibers, fumes, machinery and noise.
For this reason, you should be familiar with the regulations surrounding workers’ compensation claims for occupational illnesses and diseases. An experienced Georgia work injury attorney at Gerber & Holder Law would be happy to explain to your rights.
Common occupational illnesses and injuries
Employees in Georgia are entitled to workers’ compensation benefits, whether they suffer from a sudden, catastrophic injury or a chronic disease caused by their job environment.
For example, exposure in the workplace may lead to:
- Bloodborne pathogens
- Chemical, lead or radiation poisoning
- Industrial-related asthma or skin conditions
In addition to exposure, job-related repetitive movements or stress can result in chronic health conditions such as:
- Tennis elbow
- Trigger finger
- De Quervain syndrome
- Chronic pain syndrome (CPS)
How to prove job-related illness or injury
Georgia employees must ensure that their illness or injury is documented in the Occupational Injury and Illness Classification System (OIICS). According to the O.C.G.A. §34-9-280, employees must prove at least one of the following elements:
- The illness or injury was a direct consequence of being exposed to hazardous substances in the workplace.
- The condition was caused by exposure in the workplace and not in another location.
- The condition developed while employed at the location and is not a disorder which is common among the general public.
- The illness or injury was caused by factors within the workplace environment.
- The origin of the illness or injury was directly related to workplace risk factors.
Employees must be aware that cardiovascular disease, hearing loss, psychiatric or psychological disorders are generally NOT considered to be work-related. However, there are exceptions and some workers may be able to receive compensation under certain conditions.
What to do after a work-related illness or disease
Employees must report the illness or disease to their employer or supervisor immediately upon being diagnosed. If the incident is not reported within 1 month of the occurrence, the employee may lose their workers’ compensation benefits.
The employer must provide information concerning the facility’s workers’ compensation program. They must also provide a list of at least 6 physicians recommended by the program for diagnosis and treatment. Seeing a physician outside of the acceptable recommendations may cause a denial of the claim or require a second opinion from a qualifying physician. The physician must provide an assessment within a day after the employee seeks medical assistance.
What Georgia workers’ compensation covers
The benefits covered by workers’ compensation includes:
- Medical costs for treatment of a workplace illness or injury
- Two-thirds of an employee’s weekly wages
- Possible continuation of weekly benefits for up to 400 weeks
- Temporary partial disability (TPD) benefits secondary to injury
- Permanent partial disability (PPD) payments for a designated time period or dollar amount
- Permanent total disability (PTD) payment for people who can’t return to work
- Mileage reimbursement
- Vocational rehabilitation
- Death benefits and funeral expenses
Workers’ compensation benefits for a workplace fatality are available to a spouse, minor children or children under 22 years of age who are full-time students. Mentally or physically debilitated children of any age who are not able to work also qualify for benefits. Family members generally receive two-thirds of the employee’s wages up to the weekly maximum amount, for a period of up to 400 weeks. Spousal benefits end should they remarry or reach the age of 65.
Reasons for workers’ compensation claims denial
It’s not unusual for workers’ compensation claims to be denied, especially in cases involving occupational illness or disease. Some of the reasons why an employee can’t receive benefits include:
- The employer does not have adequate insurance coverage.
- The insurance company does not believe the illness or injury qualifies for benefits.
- The employee intentionally suffered the injury.
- The illness or injury occurred secondary to misconduct, which may include being under the influence of alcohol, illegal drugs or medication.
- The injury or illness occurred while trying to cause harm to another.
- Another employee caused the injury or sickness for personal reasons.
- The employee suffered a heart attack, stroke or other cardiovascular ailment. (However, the employee may receive benefits if they can prove that the disorder occurred secondary to work activities.)
Can you appeal a denied claim?
In the event that your workers’ compensation benefits are denied, you or your attorney must complete a Form WC-14 to request claim information, hearing or mediation issues. Then, you must mail the completed document to the address provided on the bottom of the form.
If your claim is denied a second time, you may request further assessment of your claim. The first process involves mediation, which may be followed by a workers’ compensation hearing. The next step involves a subsequent appellate review by the State Board of Workers’ Compensation. If none of these proceedings provide satisfactory results, you might be able to file a lawsuit through the Georgia appellate court system.
When to contact a workers’ compensation lawyer
Consulting with an experienced attorney who specializes in work-related injury or illness claim provides you with a legal advantage. Our attorneys can help you navigate through the complicated laws pertaining to your claim. At Gerber Holder Law, workers’ compensation is our only area of expertise. We will fight aggressively for your rights.