How to Appeal a Workers’ Compensation Claim Denial in Georgia
If you sustain a workplace injury in Georgia, you are likely eligible to obtain workers’ compensation benefits to pay for your medical expenses, lost wages, permanent disability, and/or vocational training. However, it is possible for your employer or its insurance company may deny your workers’ comp claim.
If your initial claim was denied, that doesn’t mean you cannot still obtain benefits. You have the right to appeal if your employer’s insurer claims you do not qualify for benefits.
The following are the common steps of the appeals process:
- File a Notice of Claim – If you wish to challenge an insurer’s denial of your claim, you need to file a “notice of claim” (Form WC-14) within one year from the date of your injury. Once you file the claim, you may either represent yourself through the legal process or hire an attorney. If you choose the latter, your lawyer can handle all the paperwork, meet all deadlines, and protect your rights and best interests throughout the complex legal process.
- Mediation – Before your hearing with the State Board of Workers’ Compensation (SBWC), you must go through mediation with your employer or its insurance company to try to resolve the dispute. This is an opportunity to present your case and explain why you should receive workers’ comp benefits. A mediator will facilitate negotiations between you, your lawyer, your employer, and your employer’s representative. If you cannot reach an agreement with your employer, a court hearing will be held.
- Hearing – A hearing is similar to a trial and it will take place in the county your injury occurred. You will have a chance to present your case to the judge, who will review the evidence. The judge will then decide if you will obtain workers’ comp benefits.
- Appealing the workers’ comp judge – If you do not agree with the judge’s decision, you may appeal the ruling to the appellate division of the SBWC within 20 days of the judge’s decision. If the insurance company appeals, you may file a cross-appeal within 30 days. The appellate division can either rule on your case or send the decision back to the workers’ comp judge for reconsideration.
- Appealing the SBWC review – If the SBWC rules in favor of the insurer, you may appeal the decision to Georgia’s court system within 20 days of the SBWC’s decision.