Although put in place to protect injured workers, some workers’ compensation claims are wrongly denied by insurance companies who do not want to pay. If this has happened to you, understanding the common reasons for denials can help you fight back against an unfair denial. Even if your claim was denied, you can appeal the decision with the help of a workers’ compensation attorney.
Reasons for a Workers’ Compensation Claim Denial
According to Georgia’s State Board of Workers’ Compensation (SBWC), approximately 30,000 indemnity claims are filed each year. Between 75,000 and 100,000 medical workers’ compensation claims are filed each year.
Some workers’ compensation claims are denied for simple clerical issues or because they don’t contain enough information. Denials may be due to:
- Failure to report an accident in time (Georgia’s workers’ compensation laws require injured workers to report their accident within 30 days.)
- Errors in filing the claim
- Filing a claim too late (Per Georgia’s State Board of Workers’ Compensation, injured parties have one year to file a claim.)
- Questions regarding the injury’s cause
- Dispute over the injury’s severity
Some of these reasons may be legitimate or may be used as an excuse to wrongly deny your claim.
Reporting an Accident
After a workplace accident, you are required to tell your employer that you were injured. Waiting too long to report an accident and injury could lead your employer’s insurance company to believe you weren’t actually injured at all; after all, from their point of view, you didn’t initially deem it serious enough to tell your employer or seek treatment.
As stated above, according to Georgia’s State Board of Workers’ Compensation (SBWC), waiting longer than 30 days to report an accident could result in a loss of benefits.
There are other deadlines related to filing a claim or appeal that you must meet.
Filing Errors
Official paperwork can be confusing, and you may have neglected to fill out forms correctly or in full. You also may not have provided enough evidence of your injury. A workers’ comp lawyer can help you with paperwork to ensure this doesn’t happen.
Injury Causes
You may face claim denial if an insurance company believes your injuries were actually caused by:
- A third party
- Your own misconduct
- A pre-existing condition
In any of these cases, insurers can believe they are not responsible for providing you benefits.
Injury Severity
An insurer may deny your claim if it believes you are not as injured as you claim. This denial can mean it believes you need less treatment or no treatment at all.
For a free legal consultation, call (404) 888-8888
Workers’ Compensation FAQs
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Denials are not necessarily the end of your workers’ compensation case. You are allowed to appeal decisions and can file a claim with the SBWC as long as it’s within one year of the accident.
This process can require presenting additional evidence of your injury, correcting mistakes in your paperwork, or providing testimony from doctors and other professionals about the severity of what you suffered.
What a Workers’ Compensation Attorney Can Do
You’re already dealing with an injury and lost wages. You shouldn’t have to deal with a wrongly denied claim as well. Our workers’ compensation lawyer can help you prevent denials before they happen and pursue justice in the event you are already facing a denial.
The work we can do for your case includes:
- Evaluating your case
- Gathering evidence
- Consulting experts
- Reviewing paperwork
- Meeting deadlines
- Representing you in hearings
Our attorneys handle these cases with no upfront fees. We also only charge you fees if you recover compensation. Our fee agreement means you don’t need to worry about how you will cover the costs of legal representation.
The Process of Appealing a Workers’ Compensation Denial
The first step in the appeals process is requesting a hearing with SBWC. An Administrative Law Judge (ALJ) with the SBWC will determine whether or not you deserve benefits. If you disagree with the ALJ’s decision, you have 20 days to appeal the decision with the Appellate Division.
During the Appellate Division hearing, you have five minutes to make your case. Our team will help you prepare for the hearing and help you make your case.
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Call Bader Scott Injury Lawyers Today About Your Claim
Wherever you are in the workers’ compensation process, you can call our attorneys at (404) 888-8888 to receive a free consultation. We can help with paperwork filing, evidence gathering, and appealing wrongly denied workers’ compensation claims, providing support and encouragement at every step.
Call or text (404) 888-8888 or complete a Free Case Evaluation form
