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Determining eligibility for workers' compensation

Many employees who are injured on the job can receive workers' compensation benefits in Georgia, but some specific rules apply in determining the eligibility. Even if employees are eligible, they may not have the freedom to choose all of the procedures and care providers they wish under their benefits.

The Georgia State Board of Workers' Compensation emphasizes the importance of reporting all workplace injuries to employers immediately. Reporting an injury provides documentation of the circumstances under which it occurred and begins the evaluation of an employee's eligibility for workers' compensation.

An employee is not eligible to receive workers' compensation benefits when the injury was a result of willful misconduct. Willful misconduct does not mean that employees were trying to get hurt, but rather that they were intentionally engaging in risky behavior against company safety policy. Injuries that happen while employees were roughhousing are not covered. Neither are injuries that occurred while the employee was under the influence of alcohol or drugs. On the other hand, accidents that occur due to inattention or sloppiness on the job may still be covered.

Georgian employers with fewer than three employees do not need to provide coverage, so employees of some small businesses may not be entitled to compensation if they are injured on the job. Even if an injury is otherwise eligible for benefits, coverage depends on an employee's cooperation with the investigation into the workplace incident, including submitting to a drug or alcohol test.

As WSB-TV in Atlanta reports, employers have the freedom to specify the physicians who provide services under workers’ compensation. Treatments and procedures recommended by an employee’s assigned physician can be reviewed by another physician to determine whether it is medically necessary. If found unnecessary, coverage can be refused. Some employer decisions can be appealed. Unfortunately, this can be a lengthy and frustrating process.

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