Understand the facts so you can get the best compensation in Georgia
Only a small percentage of workers’ comp cases go to trial. In most cases, the employee and their insurance company will offer you compensation without having to go to court. While many employers and their insurance providers may want to avoid offering compensation, they usually want to avoid going to court even more. In some instances, however, it’s impossible to avoid the court system. After a workplace injury, you have the choice to appeal a denied claim for workers’ compensation benefits.
Workers’ comp hearings often help you avoid the lengthy court process. However, you may still need to go to court if your claim doesn’t go as you planned.
But which is better, a workers’ comp hearing or a civil lawsuit?
What is a workers’ comp hearing?
A workers’ comp hearing may be necessary if your employer and their insurance company and other concerned parties fail to compensate you after a workplace injury or when you can’t reach an agreement about the appropriate amount of compensation.
A hearing is used to resolve disputes over issues such as:
- Mileage reimbursement
- Payment of denied medical treatment
- Changes in authorized treating physicians
- The injured worker’s ability to return to work
There are several factors that determine if your case is strong enough to appeal to a higher court. An experienced workers’ comp attorney is usually the best person to help you determine the strength of your case. Some of the factors they will consider include the severity of your illness or injury, type of claim, strength of the available medical evidence, type of health coverage you have, your ability to return to work, your income and the presence of a third-party claim from the accident.
While you are permitted to represent yourself during your workers’ comp hearing, that is generally not advisable as your employer or their insurance company will have their own attorneys who will come prepared with a strong defense.
What happens at a workers’ comp hearing?
A workers’ comp hearing is generally the last resort in pursuing compensation. Before the case goes to a hearing, there will be pre-hearing proceedings and mediation. Mediation seeks to solve the case before a hearing. At this stage, you will exchange information and negotiate with the insurance company’s lawyers and the judge. The idea is to negotiate a settlement and avoid the court process.
If you have a workers’ comp lawyer, you don’t necessarily have to be present during all pre-hearing proceedings. It’s important that you attend mediation, but you may be able to leave the pre-hearing conference to your legal representative so that you can focus on recovering. Your lawyer will guide you through the process.
Your success at the hearing is dependent on the evidence you present. You need to bring your medical records, physician’s report, unpaid medical bills and any other document that supports your claim. During the hearing, you should be ready to give a testimony and be cross-examined. Your lawyer will help you prepare for the day of the trial.
Typically, proceedings will take place over a few hours. However, if your case is complicated, it could take a few days. Prepare for the hearing as you would any other court proceeding. Wear appropriate clothes and talk with respect.
The hearing is attended by 3 parties:
- Insurance company’s lawyer
- You and your lawyer
- The judge
However, you can bring witnesses to the hearing to make your case stronger. Your employer may also send a representative, and the court may have a reporter. At the start of the hearing, the insurance company’s lawyer and your lawyer will give evidence to the judge for review.
Some of the evidence that goes to the judge may include:
- Medical records
- Medical reports
- Unsettled medical bills
- Evidence of lost wages
- Reports by expert witnesses
- Employment records
Your lawyer will know what evidence needs to be presented to the opposing lawyer before the hearing and what rules need to be followed to ensure the judge accepts your evidence.
What happens after a workers’ comp hearing?
After a workers’ compensation hearing in Georgia, the process typically follows these steps:
- Both parties submit written closing arguments. This is an opportunity for each side to summarize their case, present their interpretation of the evidence, and argue why the judge should rule in their favor.
- The judge reviews all the evidence and arguments. This includes everything presented at the hearing, such as testimony, medical records and any other relevant documents.
- The judge makes a decision. Based on the review of the evidence and arguments, the judge will issue a decision. This decision will determine issues like the extent of the worker’s injuries, their ability to work, and the benefits they’re entitled to receive.
- The decision is issued in writing. The judge’s decision is provided in a written document that details their findings and the rationale behind the decision. In most cases, you’ll be notified of the decision within 90 days after the hearing.
- There is an opportunity to appeal. If either party disagrees with the judge’s decision in the first workers’ comp hearing, they typically have the right to appeal to the State Board of Workers’ Compensation Appellate Division within 20 days. If you disagree with the decision of the Appellate Division, you also have the option to appeal to the Superior Court in the county where your injury took place within 20 days of receiving the decision from the Appellate Division. However, the Superior Court only has the power to reverse the Appellate Division’s ruling in specific, limited circumstances.
- The decision is implemented. If there is no appeal, or once the appeal process is complete, the decision becomes final and must be implemented. This could involve the payment of benefits, medical treatment, or other actions as ordered by the judge.
Your attorney will explain how to appeal a workers’ comp denial, guide you through this process, and help you decide when an appeal is and isn’t in your best interest.
What happens during a civil lawsuit?
When you file a civil lawsuit, you are suing a third party that contributed to the occurrence of your accident or illness. This usually involves a civil court, as opposed to a workers’ compensation board.
If your employer offers workers’ compensation, you generally may not sue your employer. However, you could still decide to sue any third parties who contributed or caused the accident. If you want to avoid a lengthy court process, going for workers’ compensation is better than filing a civil lawsuit.
There are, however, instances where filing for a civil lawsuit comes in handy. These include:
- If your employer’s intentional and malicious conduct was directly responsible for the accident
- If the accident was caused by a third party (not your employer)
- If the insurance company denies your claim in bad faith and you feel you deserve compensation
A civil lawsuit should be your last option. You should only go this route when you have strong evidence. Unlike a workers’ comp hearing, a civil lawsuit can take a long time to settle.
If you’ve suffered an injury or illness at work and are considering filing a workers’ comp claim or civil lawsuit, it’s essential that you speak with an experienced workers’ compensation attorney first.
Understand the process to appeal an unfair denial of your workers’ comp benefits in Georgia.
