Appealing a Denied Workers' Compensation Claim
Employees who are injured in a work-related accident may be entitled to obtain benefits by filing a workers’ compensation claim with their employer’s insurer. Unfortunately, not every claim is successful and many employees are unfairly denied the compensation they deserve. However, you may be able to reverse a denied claim by appealing the decision.
Appealing a ruling on a workers’ compensation claim in Georgia can be complicated, especially if you are unfamiliar with the state’s process of approving benefits. In this situation, it may help to consult with a Macon workers’ compensation lawyer to find out if you have options to obtain the benefits you need.
Contact Roden Law for qualified legal help during a workers’ compensation claim dispute. We know how to appeal denied workers’ compensation claims and will work to obtain the benefits you deserve for your medical expenses and lost wages. Schedule a free, no obligation consultation to learn more about how we can help you.
Why Was My Claim Denied?
There are several reasons why a workers’ compensation claim may be denied. Some of the most common reasons insurers have for denying a claim include:
- Submitting the application after the deadline: In most situations, you are required to file your claim shortly after you were injured. If you do not submit your application on time, it can be denied. You should submit your application soon after your accident. A delayed application can raise the inference that your injury is not connected to your work.
- Your employer denies work was the source of your injury: Your employer may claim that you had a pre-existing injury or that your injury did not occur at work. You are responsible for establishing the connection between your injury and your work duties.
- No witnesses observed the accident: An insurance company may be reluctant to approve a claim if the injured worker was the only one aware of it. Your employer may dispute that the accident happened in the way you claimed. A statement from a medical expert can help show that your injury was consistent with your work and your version of events.
- Your employer disputes your version of events: Your employer may claim that your accident did not occur in the way you said. The employer may say there are discrepancies in your story. The insurance company may point to different versions of the events from different statements you made.
- You did not provide medical records: Your claim may be denied if you do not provide your employer’s workers’ compensation insurer with your medical records. While the insurance company does not have a right to all of your medical file, it does have a right to records related to your injury and any pre-existing condition that may impact your claim.
Filing the Notice of Claim
To appeal a denied workers’ compensation claim, you must file a Notice of Claim form WC-14. You submit this form to the State Board of Workers’ Compensation for processing. This form requests a hearing with the board. This form must usually be filed within one year of your date of injury. Your case is then assigned to an administrative law judge.
Before the hearing, you or your employer’s workers’ compensation insurance may request to settle the disputed claim through mediation. This is an informal process that brings both parties together to discuss and resolve the claim dispute.
In some cases, the administrative law judge may order both sides to attempt to resolve the disputed claim through mediation. However if this does not resolve the dispute, your claim will proceed to a hearing.
Workers’ Compensation Hearing
Your hearing is typically scheduled within 60 days of the date of you filing a notice of claim. This is a formal hearing in which witnesses may be questioned, you will testify under oath and evidence is submitted.
Your attorney can also present legal arguments to support your case. The judge reviews all evidence and provides a written decision to support denying your claim or overturning the insurer’s decision.
If you do not agree with the judge’s decision, you may file an appeal with the State Board of Workers’ Compensation Appellate Division within 20 days of the judge’s order.
The Appellate Division usually decides your appeal based on written arguments. However you may also request an in-person hearing.
Schedule a Free Consultation Today
If your workers’ compensation claim was denied, it is in your best interests to retain an experienced workers’ compensation lawyer.
Roden Law’s dedicated team of attorneys has helped recover millions in compensation for personal injury victims. We will provide you with a free, no obligation consultation to find out if you may appeal your denied workers’ compensation claim. Our attorneys work only on a contingency fee basis, which means you only pay us if we help you recover benefits.