If you get injured at work in Georgia, you can file a workers’ compensation claim with your employer to obtain medical benefits and financial compensation for lost wages. However, your employer or its workers’ compensation insurer may deny your claim for various reasons, such as failing to report your injury on time. If you filed a workers’ comp claim and think your employer wrongly denied it, you can pursue a hearing with an Administrative Law Judge. A workers’ compensation appeals attorney from the Law Offices of William F. Underwood, III, P.C., can help.
At our law firm, we put people first, taking the time to get to know our clients and understand their needs and concerns. Our experienced lawyers will thoroughly explain your legal options and answer your questions so you have the information you need to make the best decisions in your case. We can handle the details of your appeal while you focus on your medical treatment and rehabilitation.
Contact the Law Offices of William F. Underwood, III, P.C., to discuss how a workers’ compensation appeal might help you secure the resources you need to recover from a job injury or illness. The initial case review is free.
Understanding the Workers’ Compensation Appeals Process
The workers’ compensation appeals process allows you to challenge a denial of your workers’ comp claim or request for specific benefits.
Pursuing a workers’ comp appeal begins with filing a notice of claim with the Georgia State Board of Workers’ Compensation (SBWC) within one year of the date you suffer a work injury, within two years of your last receipt of income benefits, or within one year of the date of the last authorized medical treatment paid for by the workers’ compensation insurance carrier. Filing an appeal from an employer’s denial entitles you to a hearing before an administrative law judge (ALJ). At this administrative hearing, you and your employer can present evidence and witness testimony for the ALJ to consider when deciding your workers’ comp claim.
If the ALJ rules against you, you can file an appeal with the state board’s Appellate Division within 20 days of the ALJ’s decision. The Appellate Division considers appeals via written briefs, although either party may request an oral argument. The Appellate Division may reverse a workers’ compensation claim denial when an ALJ has made a legal error or made factual findings unsupported by competent and credible evidence in the record.
If the Appellate Division upholds the denial of your workers’ comp claim, you have the option of filing a further appeal in the Georgia Superior Court within 20 days of the Appellate Division’s decision. If the court rules against you, you can appeal further to the Georgia Court of Appeals, but this appeal is discretionary. The Georgia Court of Appeals may grant your request for review but is not required to accept an appeal in a workers’ compensation case.
It’s always wise to consult a workers’ compensation attorney before initiating an appeal. Georgia’s workers’ compensation laws are complex, and minor errors can result in setbacks that delay the resolution of your case.
What Should I Do if My Workers’ Comp Claim is Denied?
If your employer or its insurer denied your workers’ compensation claim, you must put yourself in the best possible position to appeal their decision. Take these steps if you receive a notice of denial of your workers’ comp claim:
- Review your employer’s or insurer’s denial letter to understand why they denied your claim. The denial typically will come on either a form WC-1 or WC-3 Notice to Controvert. The WC-3 form is used solely to controvert or deny a claim. The WC-1 is the First Report of Injury form and may or may not include a controvert. There is an option on the WC-1 form for the Employer/Insurer to select that it is also controverting or denying the claim.
- Gather evidence that may support your claim or address the basis for your employer’s or insurer’s denial, including accident scene photos, medical records, or statements from co-workers or eyewitnesses.
- Collect your pay stubs or income statements, medical records, bills, invoices, and receipts to document your injuries and losses.
- Contact a workers’ compensation appeals lawyer immediately to initiate the appeals process.
Preparing for a Workers’ Compensation Hearing
When you file a notice of claim, the State Board of Workers’ Compensation will schedule your hearing within 60 days, but this will likely be reset several times due to the discovery process. Your hearing will occur in the county where the work accident occurred. Because a workers’ compensation hearing before an ALJ operates much like a trial, you must prepare for the hearing by gathering evidence, identifying witnesses to testify in support of your claim, and preparing your testimony if you choose to testify. An attorney who understands the protocols and procedures for a workers’ compensation appeal can guide you through the process.
Settlements, Negotiations, and Mediation in a Workers’ Compensation Appeal
Injured workers and their employers can often settle a workers’ compensation dispute and avoid the appeals process. They may informally negotiate a settlement or agree to participate in mediation facilitated by the SBWC. The State Board’s ADR Division has full-time mediators on staff. ALJs sometimes conduct mediations, too. It is also not unusual in Georgia workers’ compensation claims to hire a private mediator to conduct mediations.
In mediation, the mediator does not make any decisions or rulings. Instead, the mediator helps the parties negotiate a settlement by identifying areas of agreement and dispute, allowing the parties to understand the strengths of their cases, and suggesting potential solutions for a settlement. You can continue pursuing your workers’ compensation appeal if negotiation and mediation fail.
Why Do I Need a Workers’ Compensation Appeals Lawyer?
You can give yourself the best chance of success in a workers’ compensation appeal by having experienced legal representation. Appealing a workers’ compensation decision means following complex rules and strict deadlines. Failure to meet all requirements may cause you to lose critical rights. A workers’ compensation appeals lawyer can help you understand what to expect.
A knowledgeable lawyer can review evidence and documents in your case, including the denial letter, to begin preparing arguments and legal strategies. Your attorney will organize the evidence and testimony to craft a compelling argument for the administrative hearing. If an ALJ upholds the denial of your workers’ comp claim, an appeals lawyer can help you explore options for further appealing your case with the State Board’s Appellate Division or in court, if necessary.
Consult with a Workers’ Compensation Attorney Today
Don’t give up if your workers’ compensation claim gets denied. You can still fight for the benefits you need by filing an appeal. Contact the Law Offices of William F. Underwood, III, P.C., today for a free consultation with a workers’ compensation attorney in Georgia.
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