Determining the Validity of a Fort Oglethorpe Worker’s Comp Claim

The process of determining the validity of a Fort Oglethorpe workers’ comp claim is not generally standardized, because the validity of a claim is initially determined by the individual insurers who provide workers’ compensation coverage. Many employees who have had their claims denied find the ensuing process frustrating and complex.

In light of that, many injured employees find it helpful to work with an experienced workers’ compensation attorney throughout the process to ensure their claims are being represented properly and procedures are followed correctly, particularly for appeals.

An Overview of Workers’ Compensation

Workers’ compensation is supposed to provide relief for employees in Fort Oglethorpe who have suffered injuries on the job or illnesses caused by conditions in the workplace. Workers’ compensation is a no-fault scheme, which means that employees may receive benefits through their employer’s insurance without the need to show that the employer was somehow at fault for causing the injury or illness.

State law specifies in most cases, workers’ compensation provides the only possible remedy when employees suffer injuries in the workplace. The injured employee may not file a claim in court for damages except in rare circumstances.

Benefits of Workers’ Compensation

Benefits employees may receive through workers’ compensation are typically lesser in value than those that could be obtained from a civil lawsuit, but they are supposed to be easier to obtain because no proof of negligence or wrongdoing is required. Unfortunately, it often proves difficult for an injured employee to receive the full benefits to which he or she is entitled.

Insurance companies employ strict standards when determining the validity of a Fort Oglethorpe worker’s compensation claim. In many cases, insurance companies deny initial claims, so workers need to file an appeal in order to obtain benefits.

When a Claim Should Be Compensated In Fort Oglethorpe

As defined by Official Code of Georgia §34-9-1(4), workers’ compensation insurance provides benefits for injuries “arising out of and in the course of…  employment.” The statute specifically excludes “disease in any form except where it results naturally and unavoidably from [a work-related] accident.”

However, the law does count “aggravation of a preexisting condition by accident arising out of and in the course of employment” as an injury compensable through workers’ compensation, as long as the aggravation of the condition is the direct cause of the disability suffered by the employee. If a doctor determines that an employee’s disability is due to an underlying pre-existing condition rather than aggravation caused by work, the condition would no longer be eligible for workers’ comp coverage.

Determining Whether an Injury Occurred “in the Course of” Employment

One factor to consider when determining the validity of a Fort Oglethorpe workers’ comp claim is whether an employee’s injury occurred “in the course of employment”—in other words, whether the employee incurred their injury at a place where he or she could reasonably be expected to be performing work. Also, the injuries must have occurred while engaged in work activities or duties incidental to work, as well as during employment hours.

Determining Whether an Injury “Arose Out of” Employment

In addition to occurring in the course of employment, an injury must “arise out of employment.” This means there must be a direct connection between the injury and the duties or conditions of employment. If an employee is engaged in an activity that furthers the business of the employer at the time of injury, the injury may be said to arise out of employment.

Who Determines the Validity of Workers’ Compensation Claim?

Initially, a workers’ compensation insurance provider reviews a claim and supporting evidence to determine whether an employee should receive benefits. If benefits are denied or stopped, the employee may file a request for an appeal hearing. An administrative law judge would review the evidence and take over the task of determining the validity of a Fort Oglethorpe workers’ comp claim .

Since the process is complicated, and since insurers make use of legal counsel to support their determinations, claimants seeking benefits often choose to work with experienced workers’ compensation attorneys themselves. A seasoned attorney could assist in preparing and presenting a claim so that you are eligible to receive full and fair compensation for your work-related injury.