Helping You Move Forward After An Accident Or Arrest

When a workers’ compensation claim is denied, what can you do?

by | Apr 26, 2019 | Firm News

You work hard for your employer. When you suffered an injury in the workplace, you expected your employer to take care of you and to have your workers’ compensation claim pushed through without a problem. Unfortunately, you have found that is not the case, and now you are trying to recover and cover the mounting expenses that are the direct result of your injury and your inability to work for the time being. What can you do?

Sadly, this is a situation that numerous Georgia residents have found themselves in. Luckily, a workers’ comp claim denial is not the end of the world. There may be a way to access your benefits still. It will just take some extra work.

Why does claim denial happen?

Workers’ comp insurance providers cannot just deny a claim; there has to be sufficient reason to do so. Common reasons why claims fail to receive approval include:

  • Failing to report the injury in a specific time frame
  • Failing to file the workers’ comp claim on time
  • Medical treatment deemed unnecessary
  • Employer claims injury is not work-related
  • Employer has other reasons to deny claim
  • Injury is not compensable

The reason for your denial is not something that your employer can keep from you. Your denial letter should state specifically why your claim did not receive approval.

If it happens to you, appeal

If you know your injury happened at work and you know you did everything you were supposed to do to make sure your claim was filed on time and without error, and it fails to receive approval, you have every right to file an appeal. However, if this is something you want to do, you only have a short time in which to do it — usually about 30 days from when you received your denial notice. To appeal, you must:

  • File request to appeal
  • Provide a statement supporting your position
  • Supply supporting documentation

You may have to present your case at a hearing. This is not something you have to do alone; legal counsel can be there to represent you.

Keep fighting

Sometimes, the appeals process works, and sometimes, it does not. There is certainly no harm in trying. If the appeals process does not work in your favor, an experienced workers’ compensation attorney may be able to offer suggestions on next available steps.