If you filed a workers’ compensation claim only to have the insurer deny it, you may feel like giving up. A denial is frustrating — but there are concrete steps you can take to preserve your claim. Here are five, from our Marietta workers’ comp attorneys.
1.Determine the Reason for the Denial
First, find out why your claim was denied. The denial letter usually explains it; if not, contact the insurer and ask. Common reasons include:
- Employer disputes the claim — arguing your injury resulted from horseplay or wasn’t part of your job duties.
- Injury not reported in time — in Georgia, you must tell your employer within 30 days or your claim will be denied.
- Claim not filed in time — you must file for medical benefits within one year; claims for temporary total or partial disability must be filed within one year of your last treatment for the injury.
- Injury not covered — some injuries, such as purely psychological ones, may not qualify; in Georgia you generally need a compensable physical injury to receive benefits for a psychological injury.
2.File an Appeal Within the Time Limit
If you believe the denial was in error, note how long you have to appeal. You’ll file a Notice of Claim with the Georgia State Board of Workers’ Compensation — usually within one year of injury — and your case will be assigned to an administrative law judge. You may be required to attempt mediation; if you can’t reach agreement with the insurer, the case is set for trial.
3.Present Evidence at Trial
At trial you’ll need to present medical evidence and relevant testimony — which is exactly why experienced representation matters. The insurance company will have a seasoned legal team, and you need competent counsel to match it.
4.Pursue Further Appeals
If your claim is denied at trial, that’s not the end of the road. You have the right to appeal the judge’s decision to the Appellate Division and beyond, if necessary. Your attorney can advise you on the merits — but the deadlines at this stage are very short, so discuss your options right away.
5.Talk to an Attorney First
The last step listed here is really the first one you should take. It costs nothing to talk with our workers’ compensation attorneys about your case.