The vast majority of Georgia residents are good, hardworking people. Their jobs may not always pay well and they may wind up in hazardous working conditions at times, but they do the best they can for themselves, their families and their employers. When hurt on the job, they expect their work comp benefits to be there to get them through it — medically and financially. Unfortunately, some find their claims denied and feel they are out of luck.
When it comes to workers’ compensation benefits, a claim denial is not necessarily the end of the road. You may still be able to get the coverage you need. It just may take time and require a little legal assistance.
Why might insurance deny your claim?
Claims get turned down for a number of reasons. Some of the most common of them being:
- Failure to report the injury in the specified time frame
- Failure to submit a claim by the required deadline
- No medical treatment is necessary
- Employer denies claim
- Injury is not legally compensable
- Injury was not work related
If you file a claim and it comes back denied, the letter of denial should have an explanation as to why.
What to do if this happens
If your work comp claim does not receive approval, you can always try the appeals process. You only have a short window to file an appeal after receiving your denial letter. If this is something you wish to pursue, make sure to do it in the designated time frame — typically 30 days.
When you appeal, you’ll need to submit information regarding your claim and why you feel it was wrongly denied. As part of the appeals process, you may have to attend one or more hearings. Presenting your case alone to a judge can be rather intimidating. Thankfully, you have the right to have legal counsel present with you.
Does the appeal process always work?
Unfortunately, it doesn’t. Every case is different. There are never any guarantees. This does not mean it is not worth trying, though.
Workers’ comp benefits are supposed to be there for you when you need them. When they are not due to claim denial, there is still hope that the insurance provider will still cover your losses. An experienced workers’ compensation attorney can review your case and help you figure out the best way to proceed.