Compensation Claims: Why Are They Denied?

Workers compensation claims sometimes get denied for some strange reasons. If you get hurt on the job, you deserve to be taken care of. Your employer should pay for your medical care. They should also offer replacement wages while you’re out of work. Unfortunately, not all workers comp claims are approved. For whatever reason, your employer may deny your claim. This means your Atlanta workers compensation attorney will have to file an appeal on your behalf. Whether their appeal is successful depends on a variety of factors.

Here, we will describe some of the more common reasons why workers comp claims are denied in Georgia. We will also explain what your workers comp lawyer in Atlanta can do to challenge your denial. If you happen to have questions about your own workers comp case, give us a call. We offer all new clients a free, initial consultation. You can schedule yours over the phone or through our website.

Perhaps Your Employer Doesn’t Think You Got Hurt While on the Job

The most common reason why workers compensation claims are denied is because your employer doesn’t think you got hurt on company time. There are too many cases today where employers are taken advantage of. They have employees who come in on a Monday and fake an injury just to get some paid time off from work. They’ll investigate your social media pages to see if they can prove your injury took place over the weekend.

The Insurance Company May Think You’re Exaggerating Your Injuries In Your Compensation Claim

Even if your employer believes you were involved in a workplace accident, they may not believe your injuries are legitimate. They may believe that you’re exaggerating your injuries in your workers compensation claim. Perhaps they think you’re trying to stay out of work a lot longer than you should. Or they may feel that you had a preexisting condition that was mildly exacerbated by your workplace injury.

What will happen is your employer’s insurance carrier will investigate your past medical history. They will look to see if you have a habit of suffering from workplace accidents. They’ll also look to see if you suffered similar injuries in the past. If so, they may deny your claim, hoping that they can settle for less than the full payout on appeal.

Were You Under the Influence of Drugs or Alcohol at the Time of Your Accident?

If you were under the influence of drugs or alcohol, there is no way your compensation claims will be approved. Almost all employers in Georgia require their employees to take a drug test before they go out for treatment. They have a right to know if you were high or intoxicated at the time of your workplace accident. If your test comes back positive, your claim will be denied. And there is nothing your Atlanta workers compensation attorney can do about it.

Since your employer is the one paying for your medical care, they have a right to deny certain compensation claims. Your being under the influence of drugs or alcohol certain qualifies as one of these claims. Now, your workers comp lawyer in Atlanta can always argue that you took the drugs days before your workplace accident. Or they can submit proof that your medication was prescribed. These are hard challenges to overcome. Even if you did get hurt on the job, your attorney won’t be able to convince the insurance carrier to pay your claim.

You May Not Qualify as an Employee

One of the most frustrating things about being an independent contractor is that you aren’t entitled to certain programs. For example, you aren’t eligible to receive unemployment benefits. Nor are you qualified to apply for workers compensation claims. You must be a legal employee to receive these benefits.

If your employer has labeled you as an independent contractor, there is no way they’ll approve your claim. Your attorney will have to somehow prove that you are an employee. If they can manage to do this, you may be eligible for your workers compensation benefits. If, on the other, they refuse to acknowledge that you’re an employee, your workers comp lawyer in Atlanta can file a suit under personal injury.

Did You Report Your Injury Right Away?

In Georgia, as in most other states, you only have a certain amount of time to notify your employer that you were hurt. If you don’t report your injury immediately, there’s a good chance your claim will be denied. From your attorney’s perspective, there is never a good reason to wait to report your workplace accident. Not only do you need to get treated for your injuries, but you also need to protect your rights. If you miss the reporting deadline, your employer has a right to deny your claim. Your Atlanta workers compensation attorney will have to file an appeal and negotiate payment of your claim.

Your Atlanta Workers Compensation Claims Attorney Will Fight to Get You Benefits

If your workers compensation claim was denied, you probably know why. Your employer is required to let you know the outcome of your claim, good or bad. When you first meet with your Atlanta workers compensation attorney, make sure you bring a copy of your denial letter. Your lawyer won’t be able to file an appeal until they have this information.

Depending on why your claim was denied, your workers comp lawyer in Atlanta may be able to appeal the decision. That doesn’t guarantee that your claim will be paid. In fact, if they denied your claim once, they’ll probably deny it again. If this happens, your attorney may be able to file suit on your behalf. It all depends on the facts of your case and whether your attorney feels it has merit. If they truly don’t think you’re entitled to benefits, they’ll let you know. Our team of associates is honest and upfront with their clients. They would not want you to get your hopes up unfairly.

Since we do offer all new clients a free, initial consultation, you have nothing to lose. Come in so we can review your claim and decide what the next logical step should be.