Workers’ compensation can be technical and complicated. Many workers don’t know what will be covered and what won’t be covered in case of a workplace accident. Here are four claims that surprisingly may not be covered.
1. Scars/Disfigurement Are Not Covered
In most states, workers’ compensation covers permanent scarring or disfigurement resulting from work-related injuries—or for surgery needed to treat those injuries down the road. However, Georgia is not one of those states. Georgia is one of the few states that does not include recovery for scarring/disfigurement. They will take care of the initial injury, but scarring and disfigurement are not considered as part of your permanent partial disability (PPD) rating in the event you are receiving a lump sum award.
2. Willful Misconduct is Not Covered.
Even though in general, Georgia requires employers to provide benefits for a worker involved in a workplace accident, they sometimes try to assert an “affirmative defense”, such as the “willful misconduct” defense. In fact, 2017 saw the Georgia Supreme Court restore the “willful misconduct” defense where benefits can be denied if the employee disregards policy which results in a workplace injury. In other words, it means the worker was aware that his or her actions violated a company safety rule that would likely result in an injury. Types of willful misconduct include a self-inflicted injury, if the injury arose in an attempt to injure someone else, a violation of safety rules, or a failure to follow a duty set in by statute. If your employer is successful at using this type of defense against you, you will receive no benefits. This situation requires you consult with a workers’ comp attorney and get advice on what steps you should take next.
3. Heart Attack and Stroke Are Not Always Covered.
While it is true that heart attacks and strokes occur at the workplace frequently, they are not automatically covered by workers comp insurance. There are special rules to meet and require medical evidence, including a doctor stating that work contributed or caused the condition. This doctor may or may not be someone who examined you, or perhaps just read your file as a third party. The details of the case are very important and risk factors are considered. For instance, whether you have diabetes or hypertension are considered as both contribute to heart disease. Are you a smoker? Obese? Or do you have high cholesterol. Insurance companies are going to always argue that these factors contributed to the condition as opposed to work related factors. Without having the correct evidence to support you, you will likely lose in court. It is almost always necessary to consult with a workers’ compensation attorney in the case of heart attack or stroke for the best possible outcome.
4. Accidents While Under the Influence Are Not Always Covered.
If you are under the influence of drugs or alcohol and sustain an injury at work, and the injury was caused by your own intoxication, it may not be compensable. Now, if there is any evidence to say that the accident was unavoidable, you may still have a chance at compensation. After the workplace accident, an employer may require you to submit to testing for drugs or alcohol. And if you refuse, they may see it as an admission or presumption the injury was due to intoxication. This may turn into a denial for the claim. And if that test indicates you did have substances in your system, you have an uphill battle, but it doesn’t mean you are not necessarily eligible for compensation. Especially if it was something you took days before but just had not cleared your system. If you are ever in the situation of having to prove that intoxication did not cause your workplace injury, you must consult with a workers’ comp attorney. They will help you gather the evidence needed to appeal a denial and find witnesses, experts, etc needed to back up your claim.
Workers’ compensation is really the only recourse you have to recover benefits in the event of a workplace accident and you deserve the best possible treatment available. Make sure to consult with a lawyer if you ever have any questions or if a claim is denied. Your lawyer can offer valuable assistance to you while building a strong case of support.