Last modified: Dec 12 2020
When you report an accident to your employer, they are required to fill out an accident report (Board Form WC-1). The employer turns the report into their insurance company, and they investigate your claim.
In an "accepted" workers' compensation case, the insurance company voluntarily starts paying benefits. In a "controverted" case, the insurance company denies benefits.
However, reporting an accident is not the same thing as "filing your claim". You file your claim with Georgia's State Board of Workers' Compensation. There is a specific form you must fill out to file a workers' comp claim. (more on this below).
Filing a claim has two primary purposes. First, it prevents certain "statutes of limitations" from running on your benefits. Second, it allows you to request a hearing for workers' comp benefits. At a hearing, a judge can resolve disputes about your workers' comp benefits.
You are not required to request a hearing when you file your claim. You can file the claim as a "notice of claim only". Filing a notice of claim is generally a good idea in every case because it preserves your rights to claim benefits.
You should file a claim and request a hearing when the Employer or insurance company does not pay the benefits you are entitled to or you need to prevent a statute of limitations from running on your claim.
For example, you can request a hearing when the insurance company refuses to pay for the medical treatment or testing that you need, when the insurance company suspends your weekly workers' compensation checks, the insurance company has not paid you the correct amount of benefits, etc.
We always recommend hiring an attorney to help file your claim, but we will explain the process below.
You must file a workers' compensation claim using a specific form called a WC 14. This form is published on the State Board of Workers’ Compensation website. The form requires you to list details about your claim, including the benefits that you are requesting. The WC 14 allows you to request a hearing in front of an administrative law judge.
You file your hearing request in person at one of the offices of the State Board or mail the forms to the State Board of Workers’ Compensation, at 270 Peachtree Street, NW, Atlanta, GA 30303-1299. You must send copies of all papers to the opposing parties.
After the WC 14 is filed, the State board of workers' compensation will send you a "notice of hearing" in the mail. Hearings are held Monday through Friday at several locations around the state of Georgia. If you fail to appear, your case may be dismissed.
After you file the hearing request, both parties are allowed to conduct a process known as discovery. In discovery, an attorney may send a set of questions to answer or may schedule a time to question you in person about your claim. Likewise, your attorney has the right to send written questions to the employer or question your employer about the claim.
You are required cooperate with the process (including strict timelines for answering questions and penalties for failure to comply)
Most of the time the insurance company's lawyer will want to take your deposition. This is where the lawyer questions you in person and your responses are written down by a court reporter. Your workers' compensation attorney should prepare you for a deposition. Oftentimes an experienced attorney will be able to predict the questions that will be asked ahead of time. I always meet with my clients ahead of the deposition to prepare them on what to expect. It is also your attorney's job to object to any questions that are not appropriate.
At the hearing, you have a right to plead your case in front of a judge. The Judge will only consider evidence that is properly admitted according to the evidence code. The judge will be forced to ignore any evidence that is not properly admitted (for example, hearsay that does not fall under one of the exceptions in O.C.G.A. § 24-8-803).
After the hearing ends, the attorneys normally submit written briefs supporting their arguments.
The judge will have 60 days to issue a written opinion about whether you were entitled to the workers' comp benefits you requested. You do have a right to appeal if you think the judge has made the wrong decision. Appeals have to be filed within 20 days of the decision.
You are technically allowed to represent yourself, but it would be extremely ill advised. Any person injured in the course or scope of employment may file a claim with the State Board of Workers’ Compensation. Representing yourself in a workers' compensation claim is called being a “Pro Se Litigant”.
However, Workers’ compensation is a lot like a game of chess. The insurance company is like a grandmaster at playing the game. They have successfully defended thousands of workers' compensation claims. The insurance company will virtually always be represented by highly experienced lawyers.
The law requires certain steps to be followed, certain papers to be filed, and certain evidence to be presented for a Judge to issue an order or award. If you represent yourself, you alone are responsible for knowing and following the correct procedures
Representing yourself without the benefit of an attorney’s training and experience is not a simple matter. Below are all of the books containing the written rules that you would want to know in a workers’ compensation case.
This stack of books is over a foot tall. (Please note that this is for illustrative purposes only. I have electronic versions of these books, so some of the paper copies in this picture may be outdated editions.) From bottom to top, is a treatise explaining workers' compensation caselaw (caselaw is law that is based on judicial decisions), Title 34 of the Georgia Code (containing the 'Workers' Compensation Act'), the administrative law rules published by the State Board of Workers' Compensation, Title 9 of the Georgia Code (containing the Civil Practice Act), A treatise on Georgia Civil Discovery, Title 24 of the Georgia Code(containing Georgia Evidence code), and finally a treatise explaining caselaw on the Georgia evidence.
And that is just the written rules. There is also information that only comes with experience. For example, trial skills and etiquette at a hearing, dealing with workers’ compensation doctors, dealing with workers' compensation nurse case managers who are trying to wreck your case, settlement negotiation skills, etc.
It takes most attorneys several years of handling workers' compensation cases to become competent in this area of law.
You may retain an attorney to represent you. Under workers’ compensation law, an attorney cannot take a fee for representing you unless he or she has recovered income benefits for you. If you hire an attorney, the attorney will enter into a Fee Contract with you explaining how the attorney fee will be paid.
I am an attorney who has successfully helped thousands of injured Georgians obtain workers’ comp benefits. You do not want to do this without the help of an experienced attorney.
Lunch breaks are now covered under Georgia Workers' Comp.