What to do if your Worker's Compensation Claim is Denied?

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Workers’ compensation claim denied is undoubtedly frustrating. This denial can be for many reasons, but it is essential to know that there are steps you can take to appeal the decision with the help of atlanta workers comp attorney.

The first thing to do is to contact your employer and inform them about your situation. Your claim can be rejected for multiple reasons. Let’s look at some of them and how you can handle the situation.

Common Reasons for Workers' Compensation Denial

Knowing the reasons your workers’ compensation claim was rejected is crucial. The reason for the denial is frequently something obvious and easily fixable. However, in some instances, the denial is significantly more problematic and will need significant legal work.

Incomplete, Incorrect, or Dated Documentation

The insurance company will reject your claim if your paperwork is incomplete or inaccurate. Your application may also be rejected if your company submits the papers after the deadline. 

The Incident Happened During Lunch Break

There is a potential that the claim may be immediately rejected if you were eating lunch when the accident happened. It is imperative that you discuss this situation with a lawyer. 

You Did Not Disclose the Injury on Time

When you try to file a claim later, it may be rejected if you were hurt at work but didn’t report the injury right away. Since it wasn’t formally recorded when it happened, the insurance company believes that the accident may have occurred anywhere and at any time. 

Your Treatment Centre Was Not Authorised

You will be required to use a specified network of medical professionals recommended by your employer and their workers’ compensation insurer. The payment for that therapy may not be paid if you visit a hospital or doctor who has not been approved by the insurance provider, and your entire claim may be rejected.

You Have A Pre-Existing Condition

The insurance provider may reject the claim if you have a pre-existing condition or a prior injury and your new claim is for a comparable injury or a worsening of that injury. The insurer would probably fight this kind of lawsuit hard to demonstrate that any injuries you sustained were caused by the prior condition.

What to Do When Your Workers' Compensation Claim Is Denied in Atlanta?

Georgia law offers you the right to challenge a decision that deny you benefits. You must submit a notice of claim in order to start the appeals procedure. This notice must be submitted on the state-provided form WC-14 one year after the injury occurred. If your workers’ compensation claim is denied in Atlanta, Georgia, there are several steps you can take to try to get your claim approved:

Review the reason for the denial:

The workers’ compensation insurer should provide a reason for the denial of your claim. Review the reason carefully and make sure you understand why your claim was denied.

Gather additional evidence:

If you think your claim was denied in error, you may need to gather additional evidence to support your case. This could include medical records, witness statements, or other documentation.

File an appeal:

If you believe that your claim was wrongly denied, you can file an appeal with the Georgia State Board of Workers’ Compensation. The appeal must be filed within one year of the date of the denial.

Attend a hearing:

If your appeal is successful, you will be scheduled for a hearing before an administrative law judge. You will have the opportunity to present your case and any evidence that supports your claim.

Consider hiring an attorney:

If you are having trouble navigating the workers’ compensation process or if you think you need legal assistance, you may want to consider hiring an attorney to represent you. A workers’ compensation attorney can help you build a strong case and protect your rights.

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Deadlines for Filing Your Workers' Compensation appeal in Atlanta

In Atlanta, Georgia the reporting time of an accident is 30 days and the time for filing a claim is one year. Most of the time, filing earlier is better than filing later. The sooner you report the occurrence, the sooner the inquiry into it can start. If you wait too long, you run the danger of losing any proof of wrongdoing and witnesses forgetting the specifics. Another benefit of filing earlier is that you might be able to pay for necessary treatments and expenses and receive your benefits more promptly.

Furthermore, you might be able to sue your employer for your injuries if they don’t carry workers’ compensation insurance. It’s crucial to keep in mind that there are several deadlines that apply and that this procedure can take significantly longer than filing for workers’ compensation. Working with an expert could be helpful in these situations.

How Atlanta Lawyers Can Help You in this Situation?

If your workers compensation claim has been denied, you may be feeling overwhelmed and frustrated. Fortunately, Atlanta lawyers can help you:

  • understand your legal options and determine the best course of action
  •  provide valuable advice on how to proceed with your case
  • ensure that you receive the benefits you deserve
  •  help you understand the complex legal process
  • provide guidance on how to appeal a denied claim or negotiate a settlement with the insurance company

With their knowledge and expertise, our Atlanta lawyers are well-equipped to handle any workers compensation claim dispute. Contact us below to get a free consultation to know how you can deal with a workers’ comp denial.

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Frequently Asked Questions

You are responsible for paying any medical expenses if your workers’ compensation claim is rejected.

Yes, it is possible to appeal a worker’s compensation claim denial. The appeal process will depend on the laws of your state.

Yes, there are time limits for appealing a denied worker’s compensation claim. You will need to file a Notice of Appeal or a Request for Hearing within a certain timeframe, usually 30 days. It’s important to act quickly, as you may lose your right to appeal if you miss this deadline.

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