Possible reasons for a delay in Georgia workers’ comp benefits
Most Georgia businesses with at least 3 employees must have workers’ compensation insurance. An estimated $768 million was claimed in Georgia, according to a 2019 report. Unfortunately, the compensation doesn’t always arrive on time.
So, how long does a workers’ compensation claim take?
The workers’ compensation settlement timeframe varies depending on the situation. If the insurer accepts liability, you can get your first check in just 21 days. However, if there is a dispute, a hearing will have to take place within 60 days.
Below are some of the common reasons why some workers’ compensation claims take longer to resolve.
1. Requests for a second opinion
Insurers will always try to pay as little as possible. It should therefore not come as a surprise that insurers may request a second opinion. A second assessment must be carried out by a different physician to confirm the first. The insurer will still cover the cost of the second medical exam.
Sometimes, the treating physician may request a second opinion to confirm their assessment. You have the right to request a different opinion within 120 days. These are also known as Independent Medical Exams (IMEs).
2. You suffered multiple injuries
If you suffered multiple injuries during a work-related accident, the complexity of the claim also increases. For instance, you have broken bones, dental injuries and burns. Each of those injuries will have to be investigated separately.
It also requires experts in different fields to work on the same case. Should any of them need a second opinion, the case stops until the new results are received.
Each physician will also have to write their report on their area of expertise. The more people are involved in handling your claim, the higher the chance that errors and mistakes will be made.
3. Understaffing
Understaffing is a common problem with insurance companies. A single team can be assigned to many different cases at a time. Insurance adjusters are usually in short supply. Handling numerous cases at a time means dealing with different companies, physicians and even lawyers. Being spread so thin comes at a cost: they are more likely to make mistakes and cause delays.
Secondly, if there is a more pressing matter, they will give it more attention and leave you waiting. In some cases, the delay might be a ploy to wear you down. If you seem content waiting, your case might take longer. Follow up and keep them on their toes at all times.
4. Failure by the physicians
The injury’s extent and the course of treatment has to be agreed upon before you can receive compensation. The only way to achieve this is by conducting medical examinations. You can choose 1 of 3 ways. The first option is through a panel of 6 physicians; the second option is through a conformed panel consisting of 10 physicians. Lastly, a Managed Care Organization can do the injury assessment.
If a valid panel of physicians is not provided, you can get medical assistance from a doctor. A mistake by the treating doctor during diagnosis or treatment means there will be more disputes about your case. This can lengthen the proceedings.
5. Filing delays by your employer
All the parties involved in the chain must do their part on time. After you report the injury, your employer is supposed to notify the insurance carrier about the claim. Your employer must then complete and file Form W1-C. Any injury that led to the loss of more than 7 days must also be reported to the State Board of Workers’ Compensation. This process is compulsory and must be completed before the case can move forward.
Failure or late filing by your employer will cause delays in hearing and settlement. If the form is not filled properly or has missing signatures, they will be asked to re-do the whole process, causing further delays.
6. You made mistakes
It is easy to point fingers, but sometimes the delays might be of your own making. Failure to notify your employer on time is at the top of the list. Although the law allows for up to 1 year, you don’t have to wait that long. The longer you wait, the harder it will be to prove your case. Incomplete forms or providing inaccurate information will cost you precious time. Usually, the insurer has to request that you refill the forms.
Another way people hurt their case is during treatment. The physicians provided will examine you and recommend treatment. Failure to adhere to the guidelines may delay your healing process or worsen your condition. The insurer will most certainly bring this up during the hearing and derail the process. The fewer mistakes you make, the better.
Seek help from a professional work injury attorney in Georgia
The truth of the matter is that filing for workers’ compensation is a tedious process. Although some delays may be out of your hand, others are entirely avoidable. The best way to ensure your case goes smoothly and swiftly is by getting help from an experienced Georgia workers’ compensation lawyer.
Insurance companies have more experience when it comes to dealing with claims. Trying to handle matters personally puts you at a disadvantage. Unlike you, our attorneys know all their tricks. Let us help you so that you can focus on your recovery.
