If you were injured on the clock, you might think there’s no reason you will be denied workers’ comp benefits. However, your employer and their insurer have a strong incentive to dispute your case in order to reduce how much they have to pay out. In other words, you should expect them to dig deep to find any reason to undervalue your claim or deny you benefits.
In this article, we look at a few common reasons claims are denied and what you should do in the event of the worst:
Why Was My Claim Denied?
There are several reasons claims are rejected by insurers, and these will usually depend on the circumstances surrounding the type of injuries you suffered, nature of the accident, and the actions you took immediately afterwards. You may have received a denial letter, but this document might not have included specifics about why your case wasn’t approved.
Some of the most common reasons given for denying workers’ comp claims include:
- You Did Not Report the Accident in Time: In the state, you have up to 30 days from the date you suffered your injuries—or were made aware of your condition—to report a workplace accident to your employer. Missing this deadline could leave you unable to pursue compensation.
- You Did Not Suffer Your Injuries at Work: If your employer is able to prove that you weren’t on the clock when you were hurt, you will likely be denied benefits. To receive compensation for a workplace injury, you must be able to show that you were injured at work and performing tasks in line with your role at the company.
- You Did Not Seek Medical Treatment: You should visit the doctor as soon as possible after suffering your injuries as failing to undergo a medical assessment within a reasonable timeframe could hurt your chances of receiving benefits. Make sure that you visit a healthcare provider listed by your employer as you might not receive compensation for your medical bills if you weren’t treated by someone approved by them.
Thankfully, even if your claim was denied, you will have an opportunity to appeal the insurer’s decision. You will have to file the correct paperwork within a year of the date you suffered your injuries. The relevant forms must be submitted to the Georgia State Board of Workers’ Compensation, with a copy sent to your employer and their insurer.
After you’ve filed, a hearing will be scheduled within 60 days after the Board receives your application. This hearing takes place in front of an Administrative Law Judge and plays out much like a trial. You will have a chance to argue your case, presenting evidence that proves that you should be receiving workers’ comp benefits.
Speak to a Workers’ Comp Attorney in Atlanta Today
Filing an appeal can be a daunting prospect—especially with your financial future at stake. Thankfully, a skilled workers’ comp attorney can help alleviate stress during this challenging chapter of your life, overseeing the logistics of your case and representing you throughout proceedings.
At Moebes Law, we’ve helped many workers recover compensation in the aftermath of an accident. We know what it takes to prevail even in the most complex cases. Dial 404-354-5432 or tap through to our contact form to lock in a free case review.