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What if My Workers Compensation Claim is Denied

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  • Synopsis: Published: 2011-06-30 - Filing a workers compensation claim must be done quickly and if your claim is denied initially you can appeal. For further information pertaining to this article contact: Robbins & Associates.

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Workers' compensation is a program designed to help both employees and employers if an occupational accident occurs and a worker is injured.

Worker's compensation protects workers by providing coverage for medical expenses and loss of earnings in the even of an accident or health-related layoff.

This program also protects employers by preventing civil lawsuits against employers when they are potentially responsible for an accident. Workers' compensation benefits for a permanent disability could give an injured worker lump sum payments for that person's lifetime. Filing a workers' compensation claim must be done so quickly and the process can be confusing. If your claim is denied initially, do not worry, you can appeal.

When Your Claim Is Denied

If your claim was denied, you will receive a letter stating why. You have a choice of responding to the letter and requesting that your claim be reconsidered; or you can appeal with the help of an Atlanta workers' compensation attorney. Unless you provide additional evidence to support your claim when you are requesting reconsideration, your claim will probably be denied a second time. You also have a third option: request a hearing before the administrative law judge with the Georgia Board of Workers' Compensation. But without additional supporting documents, chances are slim that your claim will be approved. An Atlanta workers' compensation lawyer can help you prepare the strongest case possible and help you receive the money to which you are entitled.

If You Hire a Lawyer to Appeal the Decision

The first thing to do is retain an Atlanta workers' compensation attorney who is trained to negotiate with insurance companies on your behalf. These lawyers are familiar with the labor laws and how they apply to Georgia's state regulations. Most lawyers work on contingency, so their fees will be taken as a percentage of the benefits you win following litigation, limited by the State of Georgia to 25% of the benefits you receive for the first 400 weeks of benefits.

Next, request a copy of your personnel file that includes your injury (you completed this when your accident occurred). Make a copy for yourself and give one to the insurance company.

Now collect evidence, which includes medical records and supporting evidence such as:

  • Doctor's narrative reports
  • Test results
  • Emergency room reports
  • Rehabilitation progress reports on you injury and recovery
  • Witness statements
  • All bills and receipts of medical expenses relating to your injury (including transportation to and from appointments, medications, etc.)
  • Any other document(s) that support your claim

There will be a hearing that you need to attend, which will be held before a mediator or judge. You must truthfully explain the details of your accident. Be sure to fully discuss your injuries, your loss of earnings and the expenses you have incurred because of this accident.

If your case is heard before a judge or mediator, you will need to fill out a form called the Application for Adjudication with the Workers' Compensation Appeals Board. This must be completed within 12 months of filing your original claim, so do not wait if you are denied workers' compensation benefits.

Your Employer's Insurance Company

The insurance will probably try and contact you, but always refer them to your lawyer; never respond to any request (this includes email, letters, etc.). Your employer's insurance company will observe you in public. This may include recording your actions with a video camera. Be sure not to do anything that would jeopardize your claim in any way. This may be exercising, or participating in any activity that you claim you are not able to do. Not only can this disqualify your claim, you may also be prosecuted for fraud.

If you live in the Atlanta area and were denied workers' compensation benefits, please visit the webpage for Robbins & Associates, P.C., Atlanta workers' compensation attorneys, to learn more at www.robbinslaw.com



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