If you suffered an injury while working, you could be eligible to claim workers’ compensation benefits through your employer’s insurance policy. Unfortunately, sometimes insurance companies will deny workers compensation benefits for various reasons.
If you believe your claim was unfairly denied, Georgia law allows you to appeal the denial. The appeals process begins with filing a notice of the claim using the state-provided WC-14 form within one year from the date of injury.
To have the best chance of a successful appeal, we highly recommend consulting with an experienced workers’ comp lawyer at Sherrod & Bernard, P.C. We are committed to helping employees like you seek the benefits they deserve after a workplace injury.
Contact us right away for a free consultation to get started on your appeal.
What Are Some Common Reasons That Workers’ Compensation Claims Are Denied?
Workers’ compensation claims can be denied for many reasons, but that doesn’t mean you aren’t entitled to recover compensation. Some of the most common reasons that workers’ comp claims are rejected include the following:
- Failure to report — If you don’t report the injury to your employer within a 30-day window as established by state law, your claim could be rejected. However, you could seek an exception if your employer knew about your injury before the 30-day window ended.
- You weren’t injured at work — If you weren’t injured in the workplace or while doing work-related activities, it is possible that your claim could be denied. For instance, if you were hurt while driving to get coffee on a break, it’s possible you might not be covered. But if you remained on the clock during that time or were running the errand for your boss, you should be entitled to recover benefits.
- Misconduct— If your own misconduct caused the injury, that could prevent you from obtaining benefits. For example, if you were working in a construction zone and you showed up to work intoxicated, you might not be covered by workers’ compensation if you injure yourself.
- Your injuries aren’t severe enough — Often, an insurance company will admit to your injury but argue that it is not serious enough to prevent you from working.
- The injury isn’t related to your job — If you suffered an injury such as a stroke due to a pre-existing condition rather than a workplace hazard, the insurance company might reject your claim.
If your claim has already been denied once, it is crucial to get the appeal right. A skilled workers’ compensation lawyer can help you navigate the appeals process, fill out your forms accurately, and present a stronger case on the second try.
Are There Different Types of Workers’ Comp Denials?
There are two primary types of workers’ compensation denials – full and partial denial. When the insurance company issues a full denial, they are essentially saying that no injury occurred during the scope of your vocational duties.
With a partial denial, the insurance company rejects a specific part of your claim. For example, they might argue that you didn’t injure a certain body part that you say you did. In Georgia, the insurance company could also deny paying you lost income while agreeing to pay for medical benefits.
Whether the insurance company denies your full claim or a part of your claim, a workers’ compensation attorney can help you decide whether you qualify for the benefits you were denied and determine the best course of action.
Can I Appeal A Workers’ Comp Denial?
If your workers’ compensation claim was denied, you have a legal right to appeal the insurance company’s denial under Georgia law. After filing your notice of claim with the SBWC, you will proceed through the appeals process, including your hearing with an administrative law judge. Georgia law also gives you the right to appeal the decision of an administrative law judge to a higher court if you disagree with their decision.
How Do I Challenge A Workers’ Compensation Denial?
The primary steps in challenging a workers’ compensation denial include the following:
- File a notice of claim — The first step in the appeals process is to file a notice of claim on form WC-14 with the State Board of Workers’ Compensation (SBWC). You must do this within one year. If the insurance company only partially denied your claim and has agreed to pay some benefits, then you must file within one year of your last medical treatment or two years from the date you received your last weekly disability check.
- Attend mediation — You might have to attend mediation as part of the appeals process. During mediation, you might be able to negotiate a settlement with the insurance company so you can both avoid going to court.
- Attend a hearing — At your hearing, your attorney will present the evidence in your appeal before the court. The court’s judge must decide whether to rule for or against you within 30 days.
- Appellate review — If the judgment is not in your favor, you may appeal the judge’s decision with the appellate division of the SBWC. This is done by filing an application within 20 days.
- Court — If the SBWC still rules in the insurance company’s favor, you can appeal again to the courts. The appeal must be filed within a 20-day window from the date of the SBWC’s final ruling.
While you are allowed to challenge a workers’ compensation claim, it is not an easy process. Hiring an attorney could significantly improve your chances of recovering the benefits you deserve. A lawyer can also offer you legal advice and walk you through the entire process.
What Should I Expect At a Workers’ Compensation Hearing?
The workers’ compensation hearing will occur in an informal courtroom setting. You or your attorney will present your evidence before a judge. There will be no jury present because plaintiffs in workers’ compensation cases don’t have the right to a trial by jury.
It’s also important to understand that the judge’s ruling does not involve a settlement or an award. However, the judge can award benefits for medical expenses, lost income, and other miscellaneous expenses such as attorney’s fees and disability-related costs. The court can also judge whether your claim is compensable or not. The judge can essentially rule on whether you were actually injured on the job or not.
An experienced workers’ compensation attorney can help walk you through the process and represent you in the courtroom.
Contact a Workers’ Compensation Lawyer in Georgia Today
If you believe your workers’ compensation claim was unfairly denied, contact Sherrod & Bernard, P.C., at your earliest convenience. You only have a limited time to file your appeal, so there is no time to lose.
We understand that the workers’ compensation process can be complicated and stressful, which is why having trusted legal representation is so beneficial. Our attorneys could help you determine whether you qualify for benefits and present strong evidence to support your case at your appeal hearing.
Contact us today for a free case evaluation.
