Should You Appeal a Workers’ Compensation Denial? Five Important Steps to Preserve Your Claim

Should You Appeal a Workers’ Compensation Denial? Five Important Steps to Preserve Your Claim

If you filed a workers’ compensation claim only to be denied by the insurance company, you may feel like giving up. While it can be frustrating to face a denial, there are steps that can be taken to preserve your claim.

The workers’ compensation attorneys at our Marietta, GA office offer these important steps to follow to ensure your workers’ compensation claim is maintained.

Determine the Reason for Your Denial

The first step to take is to discover the reason your workers’ comp claim was denied. The denial letter you received will most likely contain this information. If not, you can contact the workers’ compensation insurer to inquire.

 

Here are some common reasons a claim may be denied:

  • Employer disputes the claim – Your employer argues that your injury was the result of horseplay, or some other disqualifying factor, such as the accident not being a result of your job duties.

 

  • Injury not reported in time – While you should report any on-the-job injury immediately, state law specifies what the maximum time limit is in each state. In Georgia, you must tell your employer about your injury within 30 days or your claim will be denied.

 

  • Claim not filed in time – Even if you informed your employer about your injury, the law limits the time period in which you can file a workers’ compensation claim. In Georgia, you must file your claim for medical benefits within one year. Claims for full or partial temporary disability must be filed within one year of your last medical treatment for the covered injury.

 

  • Injury not covered – Some types of injuries, such as psychological injuries, may not be covered. In Georgia, you must sustain a compensable physical injury in order to receive benefits for psychological injury.

File an Appeal Within the Time Limit

If you believe that the denial of your workers’ compensation claim was in error, take note of the amount of time you have to file your appeal. You must file a Notice of Claim with the Georgia State Board of Workers’ Compensation usually within one year of injury. Your case will then be assigned to an administrative law judge.

You may be required to try to settle your case through mediation. If you can’t reach an agreement with your employer’s insurer, the case will be set for trial.

Present Evidence at Trial

You will need to present medical evidence and relevant testimony at trial. This is why it is important to have an experienced workers’ compensation attorney representing you at your hearing. The insurance company will have an experienced legal team! You need competent legal representation like the skilled workers’ compensation lawyers in our Marietta, Georgia office.

Pursue Further Appeals

If your claim is denied at trial, is that the end of the story?

Not at all.

You have the right to appeal the judge’s decision to the Appellate Division—and beyond, if necessary. Your workers’ compensation attorney can advise you about the merits of your appeal and what is involved. Time limits to appeal at this stage are very short, so be sure you discuss the options with your attorney right away.

Start by Discussing Your Workers’ Compensation Claim With an Attorney

The last step listed here is actually the first one you should take!

It costs nothing to speak with the workers’ compensation attorneys at our Marietta, GA office about your case. Fees for workers’ compensation cases come from a percentage of the benefits from your claim. So, call today for your free workers’ compensation evaluation and let us put our skills to work for you.