What Is Not Covered by Workers’ Compensation?
Injured worker from his job planning to file for workers compensation claim.

Workers’ compensation pays for medical treatment and a portion of lost wages after an employee suffers a compensable workplace injury, but it does not cover every medical issue a typical Georgia worker might face.

Our Augusta workers’ compensation lawyers can help you determine if your injury should be covered by workers’ compensation. If we determine your claim for medical treatment and/or income benefits is valid, and the claim has been denied by the Employer/Insurer, we will litigate your claim and pursue all available benefits on your behalf.

After a compensable injury or illness at a Georgia workplace, Gregory Smith Law, LLC can help you deal with the complex rules of the workers’ comp system, which if not carefully followed, can cause your valid claim to be dismissed.

We’ll start by reviewing your potential claim for free. We won’t charge you a dime unless we recover benefits for you. We have the legal skills and experience to help you pursue all of the benefits Georgia law provides.

Call our GA workers’ compensation attorneys today at 706-397-3222 or contact us online to schedule your free consultation.

What Types of Injuries Are Not Covered by Workers’ Compensation?

Workers’ compensation covers job-related injuries and illnesses, which are sometimes referred to as injuries that arise out of the course of employment. This means that if employees are injured while performing their job duties during assigned work hours, they are due workers’ compensation benefits.

The Georgia workers’ comp system does not cover injuries sustained:

  • While engaging in unassigned activities that are of no benefit to the Employer
  • During an employee’s normal commute to and from work
  • While engaged in horseplay
  • If the employee was under the influence of alcohol or illicit drugs at the time of the accident
  • Because of other willful misconduct by the injured employee

Georgia’s workers compensation system will deny a claim based on an injury caused by the willful act of a third party for personal reasons such as a domestic dispute brought into the workplace. However, employees injured from an assault at work that are not personal in nature are entitled to workers’ compensation benefits. This includes sexual assault and other workplace violence committed by co-workers or the general public.

There are specific injuries not covered by workers’ compensation in Georgia. They include:

  • Scars and disfigurement. Most states provide a specific payment for scarring or non-disabling disfigurement such as facial scars. Unfortunately, the Georgia Workers’ Compensation Act does not provide payment for non-disabling scars.
  • Psychological injuries. The Georgia Workers’ Compensation Act allows for treatment of psychological injuries as long as there was some type of physical injury at the time of the accident.  Treatment for work related post-traumatic stress disorder (PTSD) is common after a workplace assault or serious accident.
  • Heart attack and stroke. Compensation for heart attacks and strokes is typically denied because both are common among the general population and difficult to link to the individual’s work duties. In some cases, it may be possible to demonstrate that a heart attack or stroke was attributable to the employee’s performance of assigned job duties; however, it would be crucial for the employee to not have underlying health issues that put them at risk, such as obesity, hypertension, or a smoking habit.

The Georgia Workers’ Compensation Act provides compensation for the aggravation of a pre-existing condition or injury. If an accident on the job aggravates a pre-existing injury, the worker is eligible for benefits as long as the aggravation is the cause of the disability. Once the aggravation resolves and the employee returns to their baseline condition, the Employer/Insurer will attempt to suspend income benefits and medical treatment.

What Benefits Are Not Included In Workers’ Compensation?

Some injured workers we represent are surprised to learn that workers’ compensation benefits are limited. The Workers’ Compensation Act provides for payment of:

  • Medical treatment related to the injury,
  • A portion of lost wages up to the maximum amount set by law,
  • Permanent partial disability benefits,
  • Funeral expenses and death benefits to a deceased worker’s dependents.

Because workers’ compensation is no-fault system, injured workers are supposed to be able to rely on benefits regardless of how or why they were injured (with exceptions as noted above). In return for providing the benefits, an employer whose negligence caused their employee’s injury is protected from being sued by the injured worker.

However, that protection does not extend to others. If a person or organization that does not employ you caused your workplace injury, such as an outside contractor or vendor working on your job site, then you may be able to seek compensation from them by filing a personal injury lawsuit.

A personal injury claim against a non-employer who caused you to be injured might seek compensation for:

  • Medical expenses
  • Lost wages and diminished earning capacity
  • Personal property damage
  • Pain and suffering
  • Punitive damages, if the accident was caused by someone exercising malice or misconduct

How you seek to resolve a work injury claim in Georgia requires full and careful consideration by an attorney who thoroughly understands the state’s workers’ compensation system. You could easily leave thousands of dollars on the table after a serious injury.

Contact an Experienced GA Workers’ Compensation Lawyer

The workers’ compensation system in Georgia is complex and confusing. An insurance company or an employer always has the upper hand against an injured worker trying to navigate the process alone. You deserve to have all the benefits that Georgia’s workers’ compensation laws provide after a workplace accident.

At Gregory Smith Law, LLC, in Augusta, GA, we have practiced workers’ compensation law for more than 25 years. We have helped thousands of people and their families across Georgia get the benefits they needed, and we are ready to assist you as well. Call our GA workers’ compensation lawyers today or contact us online to schedule a free consultation.

About the Author

Gregory Smith
Gregory founded Gregory Smith Law, LLC in his hometown of Augusta in 1993. Since that time, he has focused his practice exclusively on representing injured workers and their families after serious on-the-job accidents in Augusta and throughout Georgia. Gregory earned his undergraduate degree in accounting from Augusta College and law degree from Mercer University’s Walter F. George School of Law in Macon. He is a member of the State Bar of Georgia, Augusta Bar Association, and the Georgia Injured Workers’ Advocates, an organization dedicated to protecting the rights of injured and ill workers in the Peach State. When he’s not in the office, Gregory enjoys bicycling, fishing, and spending time with his wife and three children.