Workers’ Comp Claim Denied in Georgia? How to Appeal

In Georgia, a person is eligible for workers’ compensation benefits starting their first day of employment. These benefits are available for any employee injured at their job or due to their job. While every employee is entitled to workers’ compensation, their claims may occasionally be rejected. Here is what you should do if your claim is denied.

Why a claim may be denied

There are a few reasons that a claim may be denied. Here are a few examples:

• The case fell outside the statute of limitations

• The type of employment doesn’t have workers’ compensation (farm laborers, truck drivers, imprisoned workers, etc.)

• The injured employee was intoxicated

• Insurers think that the injury was not work-related

• There was an undisclosed pre-existing condition

Even if they deny your claim, the State Board of Workers’ Compensation (SBWC) still makes a lot of exceptions to the rules. A denial does not mean that you won’t ever receive benefits.

Sometimes, the State Board may wrongfully reject a claim. Therefore, it is a good idea to speak with an experienced personal injury attorney who can help you fight for your rights.

What to do after being denied

After you apply for workers’ compensation benefits, you will typically receive a letter explaining the status of your claim. If the SBWC denies your claim, you’ll receive the reason for the rejection. Regardless of why they denied your claim, you can file an appeal of the decision.

At this point, it is critical to hire an experienced attorney who focuses on workers’ compensation. They will help you decipher your denial letter and plan your next steps. Sometimes benefits are denied due to a simple clerical error or other misfilings. Go ahead and call the claims examiner to double-check the status of your claim.

However, if there was a different reason for your denial, you can file an appeal. In the denial letter, you will receive information about filing an appeal which will include how long you have to file and what steps you need to take. At this point, you and your attorney will be able to plan for the hearing.

In some cases, you may need to meet with a mediator before going to the hearing. Mediation is not necessarily a bad thing – it is just another avenue to discuss the injury with your employer’s insurance company.

At the hearing, you and your attorney will be able to present your side of the case. You’ll be able to show evidence and proof that your injury falls under workers’ compensation and that your employer owes you benefits.

Your evidence will include witnesses, including those present at the time of the injury and physicians who can provide your medical records. It is generally a better idea to have in-person witnesses instead of written witness testimonies. Additionally, your employer may bring their own witnesses as well.

Remember that your attorney will help you through this entire process. As long as you have followed the proper steps, you have a chance at getting the workers’ compensation benefits that you deserve.

Hire an Experienced Attorney

If you’ve been injured in the workplace and denied your benefits, calling an attorney is the best way to ensure that you get the compensation you deserve. Figuring out the following steps can be complicated, and an experienced personal injury attorney can help you understand your rights. Here at Greathouse Trial Law, we want to help you understand your rights and get the maximum compensation you deserve.

Contact us today at (678) 310-2827 or complete our online form for your free case evaluation. We aim to serve Atlanta’s great people and give a voice to the voiceless.