What to do when you’re denied workers’ comp benefits in Atlanta, GA
Under Georgia law, workers’ compensation is guaranteed to injured workers for any damages resulting from a work-related accident or occupational illness, including:
- Medical bills
- Lost wages
- Travel expenses to/from the doctor
- Vocational rehabilitation
- Death benefits (in the event of worker fatality; paid to victim’s family)
Unfortunately, many workers’ compensation claims in Georgia are denied by insurance companies, leaving the injured worker surprised, angry and confused. As the bills pile up, these individuals find it challenging to focus on recovery and instead stress about how they are going to keep their family afloat during this tough time.
At Gerber & Holder Workers’ Compensation Attorneys, our Atlanta workers’ compensation lawyers have decades of experience representing hundreds of injured workers who have been denied benefits just like you. We have the knowledge, skill and passion needed to prove that your injuries were directly related to the job-related accident and recover maximum benefits available.
Don’t give up! You still have options.
Contact Gerber & Holder Workers’ Compensation Attorneys today for your free consultation.
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How many workers’ comp claims are denied?
Each year, millions of U.S. workers are injured on the job. According to the U.S. Bureau of Labor Statistics (BLS), in 2022 alone, there were 2.8 million nonfatal work injuries and illnesses reported, an increase of 7.5% from the previous year.
While some of these injuries and illnesses were fairly minor, approximately 2.2 million injuries and illnesses were severe enough to cause workers to miss at least 1 day of work in the 2-year period of 2021 through 2022.
Ideally, these workers should be able to count on workers’ comp benefits to pay for their medical expenses and lost wages while they recover, but, unfortunately, this is not always the case.
On average, about 7% of workers’ compensation claims are denied annually. With approximately 2.8 million injuries and illnesses reported at work in 2022, that could mean as many as 196,000 denied workers’ comp claims that year.
So why are so many claims denied?
An analysis of denied claims by the National Institutes of Health revealed the vast majority of claims (78.8%) were denied because the medical provider and the patient had incorrect workers’ compensation carrier information.
In other words, often, a simple misunderstanding can result in devastating claim denial.
Fortunately, an initial claim denial doesn’t necessarily mean you can’t get the benefits you’re entitled to.
In a survey of people who ultimately received workers’ comp settlements or awards, nearly half (47%) said their claim was initially denied by the insurance company.
In cases of a denied claim, hiring an experienced workers’ compensation attorney can pay off. In fact, on average, denied claimants who hire lawyers typically have better outcomes and receive more compensation than those who don’t.
Moral of the story:You don’t always have to take “no” for an answer. A denial isn’t necessarily the end of the road when it comes to obtaining your workers’ comp benefits.
Common reasons for denied workers’ compensation claims
One of the first questions people usually ask when they find their workers’ comp claim was denied is: Why was my claim denied?
Without knowing the details of your case or reading the denial letter from your employer’s insurance company, we can’t say for sure why your claim was rejected. However, we can share some common culprits behind workers’ compensation claim denials.
Here are several possible reasons why the insurance company may have denied your claim:
- Prior workers’ compensation claims. Have you previously filed a workers’ comp claim? Insurance companies are on the lookout to deny claims for employees who have a history of making workers’ compensation claims.
- Unwitnessed accident. Without a witness, there’s unfortunately a lot of room for an insurance company to try and deny what actually occurred. They may claim that you’re not injured or, even if you are injured, that your injury occurred outside of work.
- Short-term employee. Just because you haven’t worked at your job for a long time, doesn’t mean that you don’t have a right to workers’ comp. Many times, employers will try to deny workers’ comp benefits to new employees with the hope that these employees don’t understand that they have a right to these benefits, regardless of the length of their employment.
- Accident reported after the weekend. Coming back from a holiday or weekend to report a work injury? Not so fast. Trying to prove your claim and show that your injury indeed happened at work the prior week and NOT over the weekend or vacation will be no small feat. If it’s a holiday, the claim is even harder to prove.
- Upcoming employee layoffs. When a company announces large-scale layoffs, it often leads to legitimate injury claims being denied. This is because there is a suspicion that injured workers are only claiming injuries to avoid losing their jobs.
- Disciplinary history. An excuse that many employers give for denying a claim is the past disciplinary history of the injured worker. Most times, this has absolutely no effect on their subsequent work injury and is merely a reason to delay or deny a legitimate claim.
- Refusal to go to approved doctors. If your employer or employer’s insurance company provides you with a list of approved doctors who comply with state regulations and you choose not to go to those on the list, you’re breaking protocol and opening yourself up to a potential denial of your workers’ claim.
- Prior injury to the same body part. Do you have a pre-existing injury to the body part you injured at work? Insurance companies may try to argue that your injury is due to a pre-existing medical condition and not a work-related event.
- Exaggerating injuries. If you suffered a catastrophic injury that prevents you from returning to work, your employer or their insurance company may argue that your injuries aren’t as severe as you claim to avoid paying you permanent disability benefits.
- Willful misconduct. Your employer may claim that you were engaged in willful misconduct, such as drinking and driving, using drugs or other illegal substances, failing to use provided safety equipment, or horseplay, or that you intentionally hurt yourself.
- Missed reporting deadlines. In Georgia, workers are generally required to notify their employers of their work-related injury or the discovery of their occupational disease within 30 days. If you didn’t adhere to this deadline or if you didn’t notify your employer in writing, they could use this to deny your claim.
There are many other reasons why your workers’ comp claim can be denied. If you believe the denial was reached in error, you may be able to appeal. Only by meeting with a knowledgeable attorney can you find out the exact cause of the denial and determine if you have a case for appeal.
Whatever reason the insurance company or your employer gave you, there’s one common theme behind all denied workers’ comp claims: a failure to effectively present the facts and understand your rights.
As an experienced workers’ compensation law firm, we know how to put together a strong case on your behalf. Our attorneys will thoroughly investigate the accident, interview witnesses and review medical reports and history to gain a clear picture of your accident and injuries.
How do I appeal a workers’ comp denial in Georgia?
The process for appealing a workers’ compensation claim denial can be long and difficult, which is why hiring an attorney is strongly recommended. The Georgia State Board of Workers’ Compensation (SBWC) reviews any disagreements over workers’ comp claims.
Typically, these are the steps to challenging a claim denial in Georgia:
- File a claim. If you want to challenge an insurance company’s denial of your claim, you or your attorney will likely have to file a “Notice of Claim” (form WC-14) within 1 year after your injury to the SBWC. If the insurer agreed to pay some benefits, the deadline is one year after the last medical treatment provided, or two years after the last weekly disability payment. In a survey of plaintiffs who eventually received benefits after their claim was initially denied, about half (50%) reported having to file paperwork with the state workers’ compensation agency in order to challenge the insurance company’s decision.
- Mediation. You may be asked to engage in “mediation” with the insurance company to try and negotiate a settlement agreement that both sides can agree to. According to surveys, most workers with denied claims resolve their cases through settlement talks with the insurance company (82%), rather than at a hearing (18%). If a settlement cannot be reached, however, then your case will continue through the appeals process.
- Hearing. A workers’ compensation hearing is typically an informal legal proceeding that takes place at a courtroom in the county where the injury occurred. This is where your attorney will make legal arguments and present evidence to a judge. The judge must make a decision within 30 days.
- Appellate review. If you wish to appeal the judge’s decision from the hearing, your attorney may escalate the case to the appellate division of the SBWC by filing an application for review within 20 days after the decision was issued. Generally, the appellate division will make a decision after evaluating both sides’ written arguments.
- Court. Lastly, if the SBWC and judge rules against you, you can appeal your case further by taking it to the Georgia Court of Appeals. You or your attorney must file your appeal in the county where you were injured, within 20 days after the SBWC’s final order.
Protect your workers’ comp claim by watching out for these denial tactics.
Can you refile a denied claim?
Yes, if your workers’ compensation claim is denied in Georgia, you generally have the option to appeal the decision. This process involves filing a “Notice of Claim” form and potentially requesting a hearing before an administrative law judge to present your case. The reasons for denial, such as disputes about the work-related nature of the injury or procedural issues, will guide your appeal strategy.
The outcome of the hearing can be further appealed through the state’s workers’ compensation board and, if necessary, in the state courts.
Attorney Ben Gerber and his team discuss how to spot the signs of a crooked or inexperienced work injury lawyer.
What can be done if claims are rejected or denied due to errors?
If a workers’ compensation claim is rejected or denied due to errors in Georgia, there are several steps you can take with the help of an attorney to address the situation:
- Review the denial letter. Carefully read the denial letter to understand why the claim was rejected, as this will help determine your course of action.
- Correct errors and resubmit. If the denial is due to errors in the claim, these should be corrected. Gather any additional information or documentation needed, and resubmit the claim. This might include more detailed medical records, proof of the injury occurring at work, or clarification of any discrepancies.
- File an appeal. In Georgia, workers have the right to appeal a denied workers’ compensation claim. This process typically starts with filing a Notice of Claim (Form WC-14) with the State Board of Workers’ Compensation within 1 year of the denial.
It’s crucial to adhere to all deadlines and procedural requirements throughout the appeals process. Missing a deadline or failing to meet procedural requirements can result in losing the right to appeal.
Remember, each case is unique, so the specific actions you’ll need to take can vary. Consulting with an experienced Atlanta work injury attorney can provide guidance tailored to your specific situation and increase your chance of a successful claim.
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Gerber & Holder Workers’ Compensation Attorneys: Appealing your workers’ comp claim denial in Georgia
Were you denied workers’ compensation benefits? Are you worried about how you will pay for medical bills and make up for lost wages? Don’t give up! Learn about your legal rights.
Appealing a workers’ comp denial decision is often a complex legal process that’s best handled by an experienced attorney. There are certain time limitations to filing a workers compensation claim, as well as requirements for appealing a denied claim.
At the Atlanta, Georgia law firm of Gerber & Holder Workers’ Compensation Attorneys, we can help you challenge the denial and obtain the workers’ compensation benefits you need and deserve. Our experienced workers’ compensation attorneys have been handling denied-benefit claims and fighting for the rights of injured workers for decades. We will fight to make sure you qualify for benefits because of your job injury. We will work hard to make sure your benefits are started.
