Though most Georgia employees are entitled to workers’ compensation benefits to cover their medical costs and a portion of their lost wages after a job injury, many claims get unreasonably denied by the workers’ compensation insurance carriers. This is typically done by the insurance company filing a form WC-3 Notice to Controvert and serving it on the injured worker. However, even if a worker’s claim is initially denied, they could still obtain the benefits they’re entitled to by requesting a hearing and taking the case to an administrative law judge.
Was your Georgia workers’ comp claim denied? Don’t give up without a fight. Reach out to The Law Offices of William F. Underwood III, P.C., right away. Our highly skilled workers’ compensation lawyers can review your claim to understand why it was rejected and advise you on your options for pursuing benefits. A knowledgeable lawyer can help build a strong case for you.
Common Reasons for Workers’ Comp Denials
One of the advantages of the workers’ compensation system is that qualifying claimants can receive benefits quickly. The first payment on an approved claim can come within 21 days of when you first missed work due to your injury. But if you receive a denial, you could end up with mounting medical expenses and no income while you recover.
Some common reasons why workers’ compensation claims are denied include:
- Not reporting an injury quickly enough — In Georgia, you must report your injury to your employer within 30 days of the accident. Fail to notify your employer, and you risk being automatically denied benefits.
- Not seeking treatment immediately — Similarly, if you wait to see a doctor, your employer may argue your injuries weren’t severe enough to keep you from work. See a doctor as soon as possible after your work injury, no matter how minor the injury may appear.
- Failing to follow your prescribed treatment plan — After you’ve seen a doctor, make sure you follow their orders exactly as prescribed. If you don’t, your employer can use that as justification to stop your benefits.
- Talking to your workers’ compensation insurance adjuster and/or nurse case manager directly — No matter how friendly they seem, your employer’s workers’ compensation carrier isn’t looking out for you. Their interest is in protecting their bottom line, which means they’ll use any reason they can find to deny your claim or reduce your benefits. Hiring a workers’ compensation lawyer to handle disputes can help you avoid making mistakes that could jeopardize your claim.
- Signing documents without speaking to an attorney — Never sign any documents related to your workers’ compensation claim until you’ve spoken to an attorney. You want to be sure you know what you’re agreeing to and that you’re getting all the benefits you’re eligible for.
- Not hiring an experienced Georgia workers’ compensation lawyer — The workers’ compensation claims process is complex and time-consuming. Any mistake along the way could damage an otherwise valid claim. A skilled attorney can guide you through the process to avoid unnecessary hang-ups.
Can You Contest the Insurance Carriers’ Denial of Your Claim?
After sustaining a work-related injury or illness, your first step is to gather evidence and submit a claim to the State Board of Workers’ Compensation. You’ll need to fill out Form WC-14 and submit whatever evidence you have, at which point your employer has 21 days to investigate your claim and either approve it or deny it.
If your claim is denied or you feel you aren’t getting the full amount of benefits you may be eligible for, you can request a hearing with the SBWC. A hearing will be overseen by an administrative law judge, who will look at the evidence you’ve already provided, review new documentation you may have gathered since the initial filing, and examine any counter-evidence offered by your employer.
If the judge rules against you, you can appeal further by taking your case to the full Board of Workers’ Compensation. Additional appeals can be made in Superior Court and, finally, before the Georgia Court of Appeals and possibly Georgia Supreme Court.
Do I Need a Workers’ Compensation Lawyer to Appeal?
You are not required to have a lawyer if you wish to appeal your workers’ compensation claim. However, appeals are formal legal proceedings with specific procedures that must be followed.
A lawyer familiar with the workers’ comp process can develop a strategy to make the best possible case for you. Appeals are harder to win than initial claims, and you’ll want someone with extensive knowledge and experience in your corner and advocating for your rights.
Chances of Winning a Workers’ Comp Appeal
The higher you climb up the appeals ladder, the harder it can be to win a workers’ compensation claim. Unless you have a strong legal argument as part of your appeal, higher courts will most likely stand by the decisions made by lower courts. A workers’ compensation attorney can help you gather the necessary evidence, argue on your behalf in court, and help you get the money you’re owed.
Talk To Our Workers’ Comp Lawyers Today
A workers’ compensation denial is not necessarily the end of the road. A Georgia workers’ compensation lawyer from The Law Offices of William F. Underwood III, P.C., can help you build a persuasive case for the full benefits you deserve. Call or contact us today for a free consultation.
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