Can You Appeal a Workers’ Compensation Denial?

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You applied for workers’ compensation. You feel confident in your case and spend a great deal of time getting your paperwork just right. Then the decision comes – you’re denied.

Your workers’ compensation has been denied? Now what?

If your workers’ compensation is denied, there is hope. You can appeal a worker’s compensation denial. To make your appeal successful, there are important steps to take and things to know. Our lawyers explain appealing a workers’ compensation denial.

Can You Appeal a Workers’ Compensation Denial in Georgia?

You can appeal a workers’ compensation denial in Georgia by requesting a hearing before an Administrative Law Judge. You may further appeal to the Board of Workers’ Compensation with additional appeals available to a Superior Court judge, the Court of Appeals, and the Georgia Supreme Court.

How long do you have to appeal a workers’ compensation denial in Georgia?

You have only 20 days from the date of the initial decision to request your appeal.

Don’t wait to contact our lawyers! The time frame to appeal your workers’ compensation denial is short, but we can work quickly! We can start your case today, preparing and filing your request for appeal.

Appealing Your Workers’ Compensation Claim

What are the reasons that workers’ compensation claims are denied in Georgia?

Some reasons for workers’ compensation claims denials in Georgia are:

  • The employer denies that the injury is work-related
  • A claim for benefits was not filed within one year
  • It’s necessary to explain further how the injury or disease is the result of work
  • It’s unclear what medical treatment is necessary
  • There is a miscalculation of the worker’s average weekly wage
  • The permanent disability rating is incorrect or minimized
  • The worker did not notify the employer of their injury within 30 days
  • Horseplay, intoxication, or other misconduct may have been involved

A denial may be a complete denial of all benefits, or it may be a payment that is incomplete. Our lawyers can help you identify the reason for the denial and build your appeal.

To make your appeal successful, it’s important to understand the reason for the denial. That way, you can prepare the evidence that the trier of fact needs to see at the appeal level.

How do you appeal a workers’ compensation claim denial in Georgia?

Appeals of a worker’s compensation claim denial in Georgia follow these steps:

  • Administrative Law Judge (ALJ) (hearing)
  • Appellate Division of the State Board of Workers’ Compensation
  • Superior Court
  • Georgia Court of Appeals
  • Georgia Supreme Court

You may continue to appeal your case until you receive the desired result. However, you must file the appeal promptly at each stage and present the needed information to make your claim successful.

What is the first step to appealing a workers’ compensation claim denial in Georgia?

The first step to appeal a workers’ compensation claim denial in Georgia is filing WC-14 Notice of Claim with the State Board of Workers’ Compensation. WC-14 is a document stating the person’s claim. When appealing a denial of benefits, the person should request a hearing before an Administrative Law Judge or mediation.

At Your Appeal Hearing

Your first appeal hearing is extremely important. It’s a lot like a civil trial, only the case is heard by a judge instead of a jury. Both sides can present evidence. They may cross-examine the other party’s witnesses.

This is your primary opportunity to make your case to someone with the authority to grant benefits. You must support your claim with evidence, usually medical information, but also information about your employment and income. It’s important to work quickly because most appeals are heard within 60 days from the time you file WC-14.

After your hearing, you can expect to receive a decision within 30 days. If you agree with the decision, you do not need to appeal further. (See O.C.G.A. § 34-9-102(f), requiring the court to file a decision within 30 days. The decision shall be a compensation award with findings of fact and conclusion of law. It is final unless appealed within 20 days of being issued.)

Appealing to the Appellate Division of the State Board of Workers’ Compensation

If you disagree with the decision of the administrative law judge, Georgia law allows you to pursue another appeal. You have only 20 days to file the appeal with the Appellate Division of the State Board of Workers’ Compensation.

The State Board of Workers’ Compensation assigns a three-judge panel to hear the appeal. The court doesn’t accept new testimony. Instead, they review the record from your administrative hearing. That makes your first hearing very important. The record you create at the first hearing may be critical to the success in your appeal.

You may file briefs and make arguments to the court. An oral argument must be specifically requested.

As workers’ compensation appeal lawyers, we prepare these briefs and make arguments on behalf of our clients.

The Board of Workers’ Compensation can take several actions:

  • Affirm the decision
  • Overturn the decision
  • Remand the case back to the Administrative Law Judge with instructions

The appeal panel may completely agree or disagree with the lower decision. They may also send the case back to the lower judge with instructions to do something differently that may change the outcome of the case.

Fighting for the Rights of Injured Workers

If you still disagree with the decision of the Appellate Division, you may then pursue the appeal in court. It is important to comply with procedural requirements and carefully build the evidence needed to make your case. Our lawyers can represent you throughout the process.

Lawyers Handling Workers’ Compensation Appeals in Georgia

Our lawyers are dedicated to representing the rights of injured workers in Georgia. If your claim has been denied, or you have other questions about appealing your case, we invite you to contact us for your free consultation.

We are experienced lawyers handling all aspects of Georgia workers’ compensation claims, including appeals. Contact us today to talk about your case and begin.

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