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What to Do If My Worker’s Compensation Claim is Denied in Augusta, Georgia

April 29, 2022Personal Injury

When you are injured at work in Georgia, you may be eligible for workers’ compensation benefits. This insurance pays for necessary medical expenses, short-term wage replacement, and long-term disability, which can make a major difference following an unexpected accident.

However, Georgia workers’ compensation insurers can deny claims for several reasons, leaving victims without the benefits they need. If your workers’ compensation claim is denied, you have the right to appeal the carrier’s decision.

Georgia Workers’ Compensation Laws

Under Georgia law, all businesses with three or more employees will need to provide workers’ compensation coverage. Workers are eligible for coverage beginning on the first day of their employment. 

There are certain exceptions to these requirements. Workers in any of the following professions are not eligible for workers’ compensation coverage.

  • Independent contractors
  • Volunteers
  • Domestic workers
  • Federal employees
  • Railroad employees

If an eligible employee is injured or develops an illness while performing their job duties, he or she has the right to file a claim. He or she can file a claim regardless of negligence or fault. 

The employee can recover money to pay for necessary and proper medical care and lost wages, up to a certain amount. If the injury results in permanent impairment, he or she could receive long-term disability benefits.

Why Would a Workers’ Compensation Claim Be Denied?

When you file an workers’ compensation claim, your employer’s insurance company will review it and determine whether you are eligible for benefits. There are many reasons as to why a company may deny your claim, such as the following.

  • The company does not believe that the injury happened at work.
  • You did not notify your employer of your injury within the required 30 days.
  • You did not visit an approved medical provider after your accident, or did not seek medical treatment at all. 
  • The company believes that you were intoxicated or under the influence of drugs or alcohol at the time of the accident.
  • You did not file your workers’ compensation claim forms within the required time period.
  • The insurance company believes that your injury is due to a pre-existing condition, not your work duties.

How to Appeal a Workers’ Compensation Decision

You have the right to appeal an insurance company’s decision if it denies your claim. If you disagree with any of the carrier’s decisions, you can request a hearing with Georgia’s State Board of Workers’ Compensation.

During your hearing, a judge will review the company’s decision and all relevant evidence. If the judge upholds the decision, you could file another appeal to the board’s Appellate Division. You will need to submit this appeal within 20 days of the judge’s decision.

Speak to an Attorney About Your Workers’ Compensation Claim

Navigating a workers’ compensation claim can be a challenge. You will need to build a strong case for your right to benefits and follow the correct steps to avoid a denial. If you want to appeal the decision, you will need to prepare your case for the trial-like hearing.

In these situations, it is important to speak with an Augusta workers’ compensation lawyer as soon as possible. Your lawyer can gather the evidence you need to prove your claim and guide you through each step of the process, helping you avoid potential errors. 

Contact an Augusta workplace injury attorney after your workplace accident to discuss your next steps.