Protecting Your Rights for over 25 Years

Overcoming a Denied Georgia Workers’ Compensation Claim

On Behalf of | Sep 9, 2022 | Workers' Compensation

Suffering an injury on the job or being diagnosed with a work-related illness can have a significant impact on your professional and personal life. If you are dealing with an occupational injury in Georgia, then it’s important that you file a workers’ compensation claim as soon as possible. If you find yourself facing a denial of a workers’ compensation claim, be sure to continue fighting for your rights. An attorney who specializes in Georgia workers’ compensation can help you navigate the process.

Reasons Why Workers’ Compensation Claims are Denied

1.  The claim was not filed on time. Your claim should be reported to your employer immediately after your injury. While Georgia law technically allows you 30 days to provide notice of an injury, you should report a job injury to your employer as soon as you possibly can. Insurance companies are very suspicious of claims that are reported after a delay. The longer you wait to report your claim, the more likely it is that your claim will be denied.

2. The Employer claims your injury is pre-existing. Often people who have job injuries have had some injury in the past, either from another job, a car accident, or an injury at home. Just because you have been injured in the past, that’s not a valid reason for your claim to be denied. This is true even if the injury is to the same body part. Georgia law defines a work injury to include the aggravation of a pre-existing condition. If your job activities made some a prior injury get worse, then the aggravation of that pre-existing condition is covered by workers comp.

3. The Employer is challenging the facts of the claim. Employers will go to great lengths in hopes of denying a workers’ compensation claim. The reason is easy to understand: Claims increase their insurance premiums and can cost them a significant amount of money. The employer may dispute where or when the incident took place, or whether or not you even sustained an injury. Frequently claims are not formally denied but are just ignored by the Employer, with the hopes that you’ll lose interest or give up. You have the right to medical care, and also to disability benefits if your job injury causes you to miss time from work. It is important to address those rights early in the process, and not let the Employer delay your rights to medical care and disability income benefits.

4. The Employer does not believe the claim fits the requirements of a workers’ compensation claim. Your employer may feel that your claim is not within the confines of workers’ compensation regulations. For example, the Employer may claim that you were intoxicated when a work injury took place, or that you were injured as the result of horseplay, or that you lied on your job application, or that you were not performing your job duties when you were hurt. While it is true that these issues can give rise to a valid workers comp defense, there are many exceptions to each of these defenses. Only a knowledgeable lawyer can analyze the facts and legal issues surrounding your injury.

What Should Your Next Step Be?

HIRE AN EXPERIENCED WORKERS COMP LAWYER. If you receive a notice that your workers’ compensation claim has been denied, contact a workers’ compensation attorney in Georgia as soon as possible. There are several things that need to be done quickly, just after you’ve been injured. An experienced lawyer will guide you through these steps, some of which include the following:
*  Medical Care – It is important to see a doctor or hospital emergency room as soon as possible after a job injury, and when doing so be sure to accurately report how the injury occurred and accurately report your medical history;
*  Witnesses – If any co-workers saw the injury, or were familiar with the job hazard that caused your injury, or would have come in contact with you or your supervisor shortly after the injury, it is important to talk to that co-worker quickly and have your lawyer document exactly what the witness knows. It is crucial to “pin down” the witnesses as soon as possible, before a supervisor or claims adjuster pressures the witnesses to lie.
*  Document the Posted Panel – Georgia law allows the Employer to restrict your choice of doctors, but only if they follow the proper procedure. The Employer can limit your choices to a short list of doctors (called a “posted panel”) but only if the employer displays the list in a prominent place, such as a company bulletin board, and only if the list is legally valid. It is important to locate the list of doctors just after your injury and take several legible photos of it. If the doctor list cannot be located, then take several pictures of the bulletin board so that it can be proved that the list wasn’t posted at the time of injury.

The claim denial will be presented in the form of the letter. Save this letter, as it contains important information about your claim. Your Georgia workers’ compensation lawyer will need this information to notify the proper parties and begin work on your claim.
In cases where the Employer refuses to back down, it may become necessary to schedule a hearing. Your attorney will work with you in order to prepare for hearing, which takes place in front of a judge. It is critical that you are prepared for the hearing, and that all of the evidence and witnesses that you need are available and ready to present to the judge. It is very important to hire a workers’ compensation lawyer to help you organize and present your case. If you are denied once again after this hearing, you can still move forward with the appeals process. A Georgia workers’ compensation lawyer can provide you with the expert insight that you need about the State of Georgia appeals process for workers’ compensation claims.

Ultimately, if you have been injured on the job or have suffered from an occupational illness, your first phone call should be to an experienced workers’ compensation attorney. This allows you to rest easy, knowing you will have a strong legal advocate fighting for the compensation that you deserve during this difficult and stressful time. Do not wait to begin the process of filing your initial claim or starting your appeal if your initial claim was denied. Get started on the right foot by partnering with an expert legal professional who understands the complexities of workers’ compensation programs.