Workers' Comp Denials

Workers’ Comp Denials

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If you or someone you love has been injured on the job, injured as a result of cumulative work-related trauma, or suffer from an occupational disease, workers’ compensation can provide the benefits you need for medical treatment and wage supplementation. Unfortunately, the workers’ compensation system is not an easy one to navigate, and many workers find that their initial claims get denied.

If you have recently received a workers’ comp denial, our Atlanta workers’ compensation lawyers at The Law Offices of Nathaniel F. Hansford, LLC want you to know that you are not alone. It is not uncommon for initial claims to be denied. This is because insurance companies that provide workers’ compensation to employers are more concerned about minimizing payouts and keeping premiums low for their policyholders. In short, they put profits over people.

Fortunately, you have rights under Georgia law, including the right to appeal a workers’ compensation denial you believe is wrong or made in error. Our team is available to help you step-by-step through the appeals process so you can pursue the benefits you need!

Why Choose Our Firm?

  • Our practice is focused on work injuries – it’s all we do.
  • Our awarded attorneys have decades of combined experience.
  • We’ve recovered millions of dollars in compensation for clients
  • Our staff speaks English, Spanish, Croatian & Bosnian

Trust a proven firm that knows the Georgia workers’ compensation front and back. Contact the Law Offices of Nathaniel F. Hansford, LLC for a FREE consultation!

Common Reasons for Claim Denials

Why was your workers’ compensation claim denied? The question is straightforward, but the answer might be as complicated as it is important to understand. Our attorneys can investigate your claim to figure out why the insurance company denied it, and if there are any holes in their argument that we can exploit.

The insurer might have denied your workers’ compensation claim if:

  • Insurer doesn’t believe the injury happened in the scope of your employment.
  • Insurer believes you can return to work despite your injuries.
  • Insurer claims you did not file your claim before a statute of limitations expired.
  • Employer claims you were intentionally trying to get hurt.
  • Employer claims you were intentionally engaging in a dangerous, non-work-related activity.
  • Employer claims you did not tell them about the injury in time.

Insurance Company Medical Evaluations

When an insurance company wants to deny a workers’ compensation claim but cannot find a reason upfront, it might arrange a second medical evaluation from an “independent” medical professional. During this evaluation, the medical professional will look for the slightest symptom or statement that can jeopardize the claimant’s benefits.

For example, they will often look for minor discrepancies within the patient’s medical records and use those as an excuse to deny the claim outright. Another tactic is to say that the patient’s injury is preexisting, which would not be covered by the workers’ compensation policy. The medical professional will look for a slight mention of a similar injury in the patient’s medical records and use that for the excuse.

It is no surprise that most of these medical evaluations that are arranged by the insurance company end with the medical professional saying that the injured employee can return to work. If the insurer wants you to undergo another medical evaluation, then you should notify our attorneys at once. We can help you prepare for the evaluation, or we might be able to determine that it is unnecessary and challenge it.

Appealing a Denied Workers’ Comp Claim in Georgia

If you or someone you love has been denied benefits you believe you are entitled to, you have the right to appeal the decision. Whether you were denied because you were told the injury was not related to your work, your employer is disputing your claim, or you didn’t provide the right information, our attorneys have outlined the general process below, and are standing by to help you get started!

  • Request a Hearing - After receiving a denial, you can appeal the decision by requesting a hearing with the Georgia State Board of Workers’ Compensation. Time is a factor when filing an appeal before the deadline. If you wait longer than a year from the date of your injury, you will likely lose your right to appeal and to receive benefits.
  • Mediation - Most of the time, the SBWC will require that you and your employer attend mediation, a type of informal proceeding that aims at amicably resolving disputes before they head to court. You can be represented by an attorney during mediation, and they can handle negotiations with your employer and the mediator on your behalf. Mediators, unlike judges, are there to facilitate negotiations between employee and employer, not arrive at a decision on their own.
  • Hearing – When workers and employers are unable to arrive at an agreement regarding workers’ compensation at mediation, the next step is a hearing before an administrative law judge. This hearing gives you the opportunity to present your side of the story and provide evidence that supports your argument, including medical documentation. The ALJ will then issue a decision about your benefits.
  • Appellate Division – If you are again denied benefits by the administrative law judge or disagree with their decision for partial benefits, you have the right to take the case to a higher court by requesting an appeal with the SBWC’s Appellate Division. You have only 20 days from the date of the ALJ decision to request this appeal, so it’s important to act quickly. Your case will be reviewed by the Appellate Division, which will then issue a decision. This is the last step in the appeals process.

Contact Our Firm to Learn More About Your Rights

Receiving a denial when you are depending on benefits can be a frustrating experience. By putting experienced attorneys on your side, however, you can get the help you need to better understand your rights and options, and the representation required to pursue all of the benefits you deserve. Because time is a factor in filing workers’ compensation appeals, we encourage you to reach out to an Atlanta workers’ comp attorney from our firm as soon as possible. We proudly serve all of Georgia and Alabama, and are prepared to review your case and denial immediately.

Call (770) 629-9321 for a FREE case review.

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