What to do when you’re denied workers’ comp benefits in Atlanta, GA
Under Georgia law, workers’ compensation is guaranteed to injured workers for any damages resulting from a work-related accident or occupational illness, including:
- Medical bills
- Lost wages
- Travel expenses to/from the doctor
- Vocational rehabilitation
- Death benefits (in the event of worker fatality; paid to victim’s family)
Unfortunately, many workers’ compensation claims in Georgia are denied by insurance companies, leaving the injured worker surprised, angry and confused. As the bills pile up, these individuals find it challenging to focus on recovery and instead stress about how they are going to keep their family afloat during this tough time.
At Gerber & Holder Workers’ Compensation Attorneys, our Atlanta workers’ compensation lawyers have decades of experience representing hundreds of injured workers who have been denied benefits just like you. We have the knowledge, skill and passion needed to prove that your injuries were directly related to the job-related accident and recover maximum benefits available.
Don’t give up! You still have options.
Contact Gerber & Holder Workers’ Compensation Attorneys today for your free consultation.
Statistics on denied workers’ comp claims
Denial rates for workers’ comp claims increased by 20 percent during the five-year period of 2013 to 2017, according to a benchmarking study of 273,000 claims. Further analysis of denied claims by the National Institutes of Health revealed the vast majority of claims (78.8%) were denied because the medical provider and the patient had incorrect workers’ compensation carrier information.
In other words, often a simple misunderstanding can result in devastating claim denial.
In a survey of people who ultimately received workers’ comp settlements or awards, nearly half (47%) said their claim was initially denied by the insurance company.
According to research from Lockton, a risk management and insurance consulting firm, as much as 67 percent of claims originally denied are converted to paid claims within a year.
In cases of a denied claim, hiring an experienced workers’ compensation attorney can pay off. In fact, on average, data indicates that denied claimants who hired lawyers received significantly more in compensation than those who didn’t.
Moral of the story: You don’t always have to take “no” for an answer. A denial isn’t necessarily the end of the road when it comes to obtaining your workers’ comp benefits.
Common reasons for denied workers’ compensation claims
One of the first questions people usually ask when they find their workers’ comp claim was denied is: Why was my claim denied?
Without knowing the details of your case or reading the denial letter from your employer’s insurance company, we can’t say for sure why your claim was rejected. However, we can share some common culprits behind workers’ compensation claim denials.
Here are several possible reasons why the insurance company may have denied your claim:
- The insurance company doesn’t believe your injuries are catastrophic.
- The insurance company doesn’t believe your injuries are related to a work-related accident.
- The insurance company doesn’t believe you were involved in a workplace accident.
- The insurance company believes you were hurt, but that you can work.
- Your employer claims you were engaged in willful misconduct — drinking and driving, using drugs or other illegal substances, failing to use provided safety equipment — or intentionally hurt yourself.
- Your employer claims you were injured while leaving work, but not on work premises.
- The injury or claim was not reported in time.
There are many other reasons why your workers’ comp claim can be denied. If you believe the denial was reached in error, you may be able to appeal. Only by meeting with a knowledgeable attorney can you find out the exact cause of denial and determine if you have a case for appeal.
Whatever reason the insurance company or your employer gave you, there’s one common theme behind all denied workers’ comp claims: a failure to effectively present the facts and understand your rights.
As an experienced workers’ compensation law firm, we know how to put together a strong case on your behalf. Our attorneys will thoroughly investigate the accident, interview witnesses and review medical reports and history to gain a clear picture of your accident and injuries.
How to challenge a workers’ comp claim denial
The process for appealing a workers’ compensation claim denial can be long and difficult, which is why hiring an attorney is strongly recommended. The Georgia State Board of Workers’ Compensation (SBWC) reviews any disagreements over workers’ comp claims.
Typically, these are the steps to challenging a claim denial in Georgia:
- File a claim. If you want to challenge an insurance company’s denial of your claim, you or your attorney will likely have to file a “notice of claim” (form WC-14) within one year after your injury to the SBWC. If the insurer agreed to pay some benefits, the deadline is one year after the last medical treatment provided, or two years after the last weekly disability payment. In a survey of plaintiffs who eventually received benefits after their claim was initially denied, about half (50%) reported having to file paperwork with the state workers’ compensation agency in order to challenge the insurance company’s decision.
- Mediation. You may be asked to engage in “mediation” with the insurance company to try and negotiate a settlement agreement that both sides can agree to. According to surveys, most workers with denied claims resolve their cases through settlement talks with the insurance company (82%), rather than at a hearing (18%). If a settlement cannot be reached, however, then your case will continue through the appeals process.
- Hearing. A workers’ compensation hearing is typically an informal legal proceeding that takes place at a courtroom in the county where the injury occurred. This is where your attorney will make legal arguments and present evidence to a judge. The judge must make a decision within 30 days.
- Appellate review. If you wish to appeal the judge’s decision from the hearing, your attorney may escalate the case to the appellate division of the SBWC by filing an application for review within 20 days after the decision was issued. Generally, the appellate division will make a decision after evaluating both sides’ written arguments.
- Court. Lastly, if the SBWC and judge rules against you, you can appeal your case further by taking it to the Georgia Court of Appeals. You or your attorney must file your appeal in the county where you were injured, within 20 days after the SBWC’s final order.
Attorney Ben Gerber and his team discuss how to spot the signs of a crooked or inexperienced work injury lawyer.
Our record of winning accident cases in Georgia speaks for itself:
Gerber & Holder Workers’ Compensation Attorneys: Appealing your workers’ comp claim denial in Georgia
Were you denied workers’ compensation benefits? Are you worried about how you will pay for medical bills and make up for lost wages? Don’t give up! Learn about your legal rights.
Appealing a workers’ comp denial decision is often a complex legal process that’s best handled by an experienced attorney. There are certain time limitations to filing a workers compensation claim, as well as requirements for appealing a denied claim.
At the Atlanta, Georgia law firm of Gerber & Holder Workers’ Compensation Attorneys, we can help you challenge the denial and obtain the workers’ compensation benefits you need and deserve. Our experienced workers’ compensation attorneys have been handling denied-benefit claims and fighting for the rights of injured workers for decades. We will fight to make sure you qualify for benefits because of your job injury. We will work hard to make sure your benefits are started.