Helping You Move Forward After An Accident Or Arrest

Why was my workers’ comp claim denied?

by | Feb 20, 2019 | Firm News

Whether you work in construction, manufacturing, retail or some other industry, you count on workers’ compensation to cover you if you are injured on the job. Additionally, workers’ comp covers treatment for medical conditions that develop as a result of your work, such as carpal tunnel.

Since illness or injury often results in lost wages, medical bills and other expenses, you depend on the law that requires your employer to provide you with this coverage. However, since workers’ compensation comes through insurance companies, you may not always have a guarantee that the insurer will accept your claim, and this may leave you in a very bad financial situation.

Common reasons for claim denials

Under Georgia law, workers’ compensation pays for your medical care, temporary or permanent disability, and lost wages following a workplace accident. The purpose is two-fold. First, workers’ compensation provides you with funds regardless of fault to eliminate the need to file a lawsuit against your employer. Secondly, the program aims to get you back on your feet and back to work as quickly as possible. Nevertheless, the insurer may deny your claim for any of these and other reasons:

  • You missed the deadline for reporting your injury. Each state has a time limit for informing your employer of an accident or injury, and in Georgia, you have 30 days.
  • You missed the deadline for filing a claim with the insurer. Again, this varies among the states, but Georgia allows one year after your injury.
  • State policies do not cover your injury or illness. For example, Georgia law does not cover depression or other psychological conditions unless they result from another workplace injury.
  • Your employer denies that your injury took place within the scope of your duties. For example, he or she may claim you were intoxicated at the time of the accident or that you were intentionally violating safety protocol.
  • You did not seek medical treatment for your injury, or you did not follow through with medical advice from your doctor.

You may have to demonstrate the validity of your claim by gathering medical documents or even obtaining the second opinion of a doctor. Nevertheless, you will likely have to file a formal appeal if the insurer denies your claim, and that carries another deadline. You would be wise to seek the assistance of an attorney who is familiar with Georgia’s workers’ compensation laws.