Appeal a Workers Compensation Denial in Atlanta
Did you or a loved one get injured at work and denied your workers comp benefits? Don’t lose hope! Atlanta employees have the right to appeal a workers compensation denial, and The Law Offices of Darwin F. Johnson can help! We understand how frustrating it can be to go through the lengthy process of an injury claim to have it denied. Our legal team understands the emotional, physical, and financial struggle you are going through and will help you file a strong appeal.
As a premier workers’ compensation firm for employees and their families throughout Gwinnett County, GA, we have over four decades of experience in these matters. Read on to learn more about why workers comp claims get denied and how our representation can make a difference!
Why Did I Receive a Workers Compensation Claim Denial?
Why a workers’ compensation claim gets denied can stem from several causes. More confusing is that you can receive a partial denial while the Georgia State Board of Worker’s Compensation (SWBC) accepts the other portion of your application. This is why an appeal is critical to ensure that you have the opportunity to clear up any issues with your original claim and get the approval you need.
To better understand why denials happen, below is a list of the top ten culprits:
Your Injury was Non-Work-Related
A common misconception that many workman’s compensation filers don’t understand is that benefits are for injuries that happened due to employment-related circumstances. If you are riding your bike to get lunch and crash, breaking your ankle, this isn’t a work injury.
You Filed a Claim After Being Fired or Laid Off
Even if you were legitimately injured at work and didn’t have time to pursue a claim, filing after leaving the company is difficult. Insurers rarely are willing to accept this type of claim situation and try to claim it is a revenge action on your part. This scenario is why you should always file your injury claim right away. Trying to convince the insurer and or an SBWC judge that you did have a workplace injury under these circumstances rarely gets approved.
Your Own Negligence Caused Your Injuries
Georgia’s workers compensation is a no-fault system, but there are situations where you might jeopardize your eligibility. In cases where you were intoxicated on the job when getting hurt or breaking clear company policy, you may not qualify. These behaviors may also include some forms of roughhousing and practical jokes that have no benefit to your employer.
Not Submitting Necessary Documentation
Documentation is vital to any work injury claim. This includes submitting a notice of your injuries to your employer in writing within 30 days of the incident. If your employer failed to fill out a Georgia first report of injury form, you could also find yourself denied. Another essential piece of paperwork is a physician’s letter regarding your health condition. If it doesn’t clearly link a work-related accident to your disability or injury, you could receive a denial.
Having a Pre-Existing Condition Can Lead to Denials
Even if you have a pre-existing condition that gets aggravated by a workplace injury, it’s not uncommon to receive a denial. Keep in mind that you cannot receive benefits for that condition, only the aggravation of it, along with any new injuries you sustained. Failing to disclose this health issue can also lead to a denial.
You Weren’t Injured at Work
You have to be hurt while performing duties related to your job. Your morning commute you make to work generally doesn’t fall under a work injury. Typically, one must be at their job site working when an accident occurs to qualify for workers compensation coverage. There are some exceptions for those who do travel as part of their job role.
The Severity or Nature of Your Injury or Disability is Unbelievable
Any time an insurer doesn’t believe you are actually hurt or disabled, they will issue a worker’s compensation denial. This often occurs if an employee just wants time off to rest the injury and doesn’t get medical care for it. To qualify for coverage, you must actively seek treatment and undergo an exam documenting your condition. Usually, the physician you see will be a preferred provider chosen by your company’s workers compensation insurance company.
This makes working with a Gwinnett County workplace injury attorney like those at The Law Offices of Darwin F. Johnson a critical first step. We can ensure that your rights and best interests are the number one priority throughout the claims process.
You Have the Right to Appeal Workers Compensation Claim Denials in Gwinnett County
When you get hurt at work, the hardships your injuries put on your household can pile up quickly. Being unable to work and pay your bills coupled with needing medical care is overwhelming. The physical trauma of your accident requires rehabilitation and makes the prospect of returning to work feel impossible.
Georgia workers compensation was designed to help alleviate the financial impact of unexpected and debilitating job injuries. But what options do you have once you receive a denial letter? You can’t return to work in your current condition, and the idea of having to file an appeal can feel like a hopeless battle. Fortunately, with proper legal guidance and experienced representation by your side, you don’t have to accept your loss.
As mentioned earlier, there are countless reasons why workers comp claims get denied. Often, insurers do so unfairly and can get away with it because of how complex state law is regarding workers’ compensation. If you live in Gwinnett County, GA, you can have the decision reviewed by the Georgia SWBC, and if that gets denied, you can file an appeal in court. This step requires the premier worker’s comp attorneys at The Law Offices of Darwin F. Johnson. You can trust our decades of combined experience to build and position your case favorably with the court.
How Do I Appeal a Workers Compensation Denial in Atlanta?
If you believe you are entitled to benefits but get denied, state law allows you an appeal. Regardless of why you received a denial, at The Law Offices of Darwin F. Johnson, we know how companies and their insurers manipulate the system. Our workers compensation attorneys help Atlanta area workers every step of the way. Below is a brief step-by-step overview of the appeals process in Georgia:
Hearing with the Board
Upon receiving your initial denial, you and your attorney will appeal the decision in a hearing with the Georgia State Board of Workers Compensation. You only have one year from the date of your injury to file, and then you lose your right to appeal. If you receive a denial at the review, the next step is heading to court.
Usually, before you can take your case to the courtroom, the SBWC requires all parties involved to enter mediation. This is a type of proceeding that focuses on avoiding litigation by working with a neutral mediator to come to a resolution. These representatives don’t have the authority to make any decisions on your case and are simply facilitating the negotiation process.
If mediation fails, your attorney will then request a hearing before an administrative law judge. This proceeding allows you to present your case and supporting evidence to the judge, who will then issue a benefits decision.
Should the administrative judge deny your benefits request, the next step is to file to appeal appeal a workers compensation denial with the appellate division of the SBWC. You must complete your request within 20 days of receiving the denial for the Appellate Division to make a decision. This is the final step available in the appeals process.
Due to the complex nature of worker’s compensation denial appeals, you are allowed to have an attorney represent your case throughout the process. A highly skilled Atlanta work comp lawyer is your most valuable asset. The Law Offices of Darwin F. Johnson not only provide a fair evaluation of your work injury circumstances, but we can determine your eligibility for worker’s compensation benefits.
Trust Darwin F. Johnson with Your Workers Compensation Denial Appeal
If you recently suffered a serious work injury and had your compensation claim denied, you need a knowledgeable Gwinnett County workers’ compensation attorney. Don’t let a denial stand in the way of benefits you rightly deserve and need to recover. At The Law Offices of Darwin F. Johnson, we can ensure that your appeal is filed quickly and gets the representation it needs to be taken seriously.
Our over forty years of representing worker’s compensation claims throughout Atlanta has made us the premier firm to rely on when employers dispute worker injuries. We understand that the primary motivation for denials is saving money on insurance premiums. The talented workman’s comp attorneys we have in our law practice won’t let that stand. Your physical, emotional, and financial well-being are of the utmost importance to our legal team. Call us to set up your free consultation at (404) 882-9237 or contact us online to schedule an appointment today.