Most employees who are injured on the job in Georgia have the right to file a workers’ compensation claim. Workers’ compensation pays the injured worker’s medical expenses and a portion of lost wages each week.
Workers’ compensation is a no-fault program, meaning an eligible employee can receive benefits when injured on the job regardless of how the accident happened (with a few limited exceptions). If a workers’ compensation claim is denied, it is typically because of:
- Questions regarding causation or the severity of the injury and degree of disability,
- Questions regarding the injured workers’ eligibility for benefits, and;
- Questions regarding whether the injury was pre-existing and not aggravated by the workplace accident.
It is not unusual for a workers’ compensation claim to be denied by the Employer/Insurer. An injured worker has the right to request a hearing from the Georgia State Board of Workers’ Compensation (SBWC) to have an Administrative Law Judge rule on the issues in dispute. At this point, it is critical for the injured worker to turn to a Georgia workers’ compensation lawyer for assistance. The Employer and Insurance Company have attorneys that know the workers’ compensation system inside and out. Every injured worker whose claim is denied needs someone in their corner who knows the system too.
The workers’ compensation attorneys at Gregory Smith Law, LLC in Augusta, GA, have the legal skills and experience to help injured workers through the hearing process. We can give you the best chance of obtaining the benefits you deserve. Contact us for a free claim review and discussion about how we can help you if you have been wrongly denied benefits.
Why Do Workers’ Comp Claims Get Denied?
There are many reasons why a workers’ compensation claim may be denied. In our experience, many denied claims are legitimate claims that should be accepted and paid. Some of the most common reasons claims are denied include:
- You missed the deadline to submit your claim.
- The claim application has incomplete or inaccurate information.
- The insurance adjuster does not have the medical records to document your injury.
- The employer denies that your injury occurred at work.
- The employer denies your injury is disabling.
- The insurance company disagrees with the recommended medical treatment, such as surgery.
- Your employer claims that you were an independent contractor, and not eligible for benefits.
- Your employer claims that your injury is from a pre-existing condition and unrelated to your workplace accident.
The SBWC will deny a claim if you were injured while engaged in willful misconduct such as fighting or horseplay, or if your injury was caused by the use of alcohol or illicit drugs.
You will jeopardize your claim if you:
- Fail to report injuries promptly.
- Refuse to submit to a scheduled medical examination by the authorized treating physician.
- Fail to cooperate with your employer and treating physician regarding medical evaluations, treatment and rehabilitation services.
- Refuse to take a drug test within eight (8) hours of the time the injury occurred.
If your claim is denied, you have the right to request a hearing from the State Board of Workers’ Compensation. At this point, you will need an experienced workers’ comp attorney to help prepare your case for trial.
Can I Sue My Employer For Denying Workers’ Comp?
Workers’ compensation benefits are considered the exclusive remedy for any liability your employer may have for an on-the-job injury. If you are denied benefits, there is a multi-level process you may use to pursue benefits.
The first step after workers’ comp benefits have been denied is to request a hearing before an administrative law judge (ALJ) of the State Board of Workers’ Compensation. Once a hearing has been scheduled, each side is allowed to gather evidence during the discovery process. The discovery process involves the insurance company attorney and your attorney exchanging information. At the hearing, which is to be held within 90 days of the request, the ALJ will hear testimony from both sides and decide whether benefits should be paid.
If you are unhappy with the administrative law judge’s decision, you may appeal to the State Board’s Appellate Division. The Appellate Division consists of a chairperson and two other Board members, who serve as appellate law judges.
By law, the Appellate Division must accept the administrative law judge’s findings of fact as long as they are supported by a preponderance of competent and credible evidence.
Most claims are decided at the ALJ hearing or at the Appellate Division. Subsequent appeals are more formal and limited, and go before:
- The Superior Court of the county where the injury occurred,
- The Georgia Court of Appeals, then possibly,
- The Supreme Court of Georgia.
The Appellate Division and higher courts do not hear from new witnesses. These courts are bound by the facts and evidence that have already been established. The Georgia Court of Appeals and the Supreme Court of Georgia can decline to hear cases and typically only accept a case that involves a potential new interpretation of the law.
How Can an Attorney Help Me If My Workers’ Compensation Was Denied?
As your attorneys, Gregory Smith Law can review your claim for workers’ compensation benefits and ensure that you move forward through the hearing process with the best chance possible of winning your case. We will work to:
- Prepare your case for the hearing. If your claim was denied by your employer or its insurance company, we will review your claim information, collect all of the medical records related to your injury, and depose any fact witnesses that may have knowledge of how the injury occurred. We will also obtain the deposition testimony of any medical providers who can support your claim for disability and causation.
- Prepare you for the hearing. A hearing before an Administrative Law Judge can be intimidating for people who have never had to testify in court Our attorney can prepare a solid case, help you understand what you should expect at the hearing, and inform you of the questions the insurance company lawyer will likely ask. Our Georgia workers’ compensation lawyer knows what it takes to build a persuasive case for full benefits.
Talk to a Georgia Workers’ Comp Lawyer Now
If your Georgia workers’ compensation claim has been denied, it is important that you understand that you have the right to request a hearing before an Administrative Law Judge of the State Board of Workers’ Compensation. It is crucial that you speak to an Augusta workers’ compensation lawyer who can guide you through the complex hearing process.
At Gregory Smith Law, LLC, we can determine why your claim was denied and support you through every step of the hearing process. When you have been denied workers’ compensation benefits or your claim has been underpaid, we are here to help. Call us today or contact us online to schedule your free consultation with our workers’ comp attorney.