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Insurer ordered to cover cost of Georgia employee’s injuries

A Georgia construction company that does greenhouse repair and maintenance apparently inaccurately filled out an application for a workers’ compensation insurance policy. The insurance agent indicated on the new policy that the company only did work here in Georgia, but the reality was that it did much of its business outside of the state.

So when one of its worker was injured on a job outside of the state, the insurer balked at covering the costs of Georgia workers’ compensation benefits. However, the three-judge panel of the Court of Appeals of Georgia, 4th Division, has ruled that the insurer failed to show that its policy was void and must therefore cover the workers’ comp costs.

The insurance agent not only misstated the geographical areas in which the construction company did business, but she also misclassified it as a janitorial service in which workers did not perform their jobs above 15 feet.

The construction company claimed that it told the agent that the policy had to be adjusted because 85 percent of its business was outside of Georgia.

When the insurer investigated the company, it concluded that it would not have issued the policy had the policy application accurately stated that the company does work in 30 states. In early March of 2015, the insurer sent the company a cancellation notice that gave the construction firm 90 days to find a new insurer.

But a day before the notice was sent, an employee suffered extensive injuries and filed a workers’ comp claim.

An administrative judge held that the injuries were covered under Georgia law, and the insurer appealed to the Georgia Board of Workers Compensation, but the board upheld the previous finding. A Superior Court affirmed the board’s decision, and after the insurer’s appeal, the appellate court handed down its decision in favor of the employer.

Everyone in a workers’ comp dispute has legal rights that can be vigorously defended, including first and foremost, the injured worker. Those employees denied benefits have the right to appeal that decision with the help of a qualified Jonesboro workers’ comp attorney.