Insurance companies are in the business of making money and holding on to it, and they are constantly looking for any reason they can to deny or reject your claim to avoid paying you money. Sometimes their reasons are valid, other times they are not.
Below are some of the most common defenses used to deny claims:
This argument is raised most frequently when a general contractor is the alleged employer. The insurance company may argue that the general contractor hired a subcontractor, who then hired the Employee and therefore, the subcontractor’s insurance is on the hook.
However, Georgia law provides for what is called a statutory employer. Essentially, the general (or principal) contractor can potentially be held liable for compensation to an injured employee while employed by a subcontractor that did not carry insurance.
This defense is used when claiming either that the Employee was never injured in the first place, the Employee had the injury prior to working for the Employer, or the Employee sustained the injury while employed with the Employer but not while actually performing work for the Employer (i.e. falling down the stairs of your home on your way to work).
This can be tricky because there are several different statutes of limitations under Georgia workers’ compensation laws. The general rule is that the Employee must file a claim within one year of the date of injury.
However, this time frame may be extended if the Employee received medical treatment, weekly checks, or both from the insurance company. In that case, the Employee has one year from the date of last remedial medical treatment furnished by the Insurer or two years from the last payment of weekly income benefits to file a claim.
Be careful with this one. While it is a valid defense, it is not enough that the employee simply failed a drug test. The insurance company must also prove that the accident which caused the injury was the result of being under the influence.
Only employees can receive workers' compensation benefits. Sometimes, employers will attempt to claim that the employee is actually an independent contractor and therefore not entitled to file a workers' comp claim.
The success of this defense hinges on whether the "independent contractor" is truly an independent contractor or if they are actually an employee disguised by the employer as an independent contractor.
The easiest way to make the distinction between independent contractor and employee is to look to the employer's control over the time, manner, and methods of the job to be completed. The more control the employer exercises over these factors, the more likely there is to be a finding of an employer/employee relationship.
Here are some questions you can ask to determine how much control the employer has:
Is the job you are doing part of the employer's regular business or is it an additional service? If it is a regular part of the business, employee is most likely.
Does the employer supply the tools necessary to perform your job or do you supply your own tools? If the employer supplies the tools, employee is most likely.
Does the employer tell you when you can start and end your day or do you make your own schedule? If the employer determines the schedule, employee is most likely.
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The Barionnette & Eisenhower Law Firm, LLC
2310 Parklake Drive, Suite 460 - Atlanta, GA 30345
P: 404-225-1501 — F: 678-305-0908