The Top 7 Reasons Why Employers Deny Workers Comp Claims

Workplace injuries can be devastating, both physically and financially. That’s why workers’ compensation exists – to provide employees with the support they need in the event of an accident or illness on the job. However, there are times when employers deny these workers comp claims, leaving injured workers feeling helpless and frustrated.

In this blog post, we’ll explore the top 7 reasons why employers may deny a workers comp claim, and how a skilled Atlanta workers’ compensation lawyer can help you fight back and win your case.

How Does Workers’ Compensation Work in Georgia?

The workers’ compensation system provides benefits to employees who are injured or become ill as a result of their job. Benefits can include medical expenses, income replacement, and death benefits. Workers compensation is typically mandatory in most states, meaning employers must provide coverage for their employees.

In Georgia, employers are required to provide workers’ compensation coverage for their employees if they regularly employ three or more people in their business.

If you are injured at work, you will need to file a claim with the State Board of Workers Compensation. If your workers comp claim is approved, you will receive benefits including medical expenses and income replacement. If your claim is denied, you have the right to appeal the decision.

An experienced Atlanta workers’ compensation lawyer can help you navigate the appeals process and give you the best chance of success.

Reasons Why Employers Can Deny Your Workers Comp Claim

If your employer has denied your workers’ compensation claim, it is important to seek legal assistance as soon as possible. Here are some of the most common reasons why employers deny a workers comp claim:

1. You Did Not Immediately Notify Your Employer of the Injury

If you were injured at work and did not immediately notify your employer, they may use this against you in your workers comp claim. They may argue that if you had truly been injured, you would have notified them right away.

A workers comp attorney in Atlanta can help you prove that your injury was not immediately apparent and that you notified your employer as soon as possible.

2. The Injury Did Not Occur in the Course of Employment

If the injury did not occur in the course of employment, the employer may deny the workers comp claim. To win your case, you will need to prove that the injury occurred while you were working. A lawyer can help you gather evidence to support your claim.

3. Pre-Existing Conditions

If you have a pre-existing condition, your employer may be more likely to deny your workers comp claim. This is because they may believe that your condition is not related to your work. A medical report will most likely be able to prove that your work injury was not a result of your pre-existing condition and that you are entitled to benefits under workers’ compensation.

4. Lack of Evidence Showing an Injury Occurred at Work

Employers routinely deny workers comp claims if there is a lack of evidence that an injury actually occurred at work. If you’re filing a claim for a work-related injury, it’s important to have as much documentation as possible to back up your claim.

Medical records showing the nature and extent of your injuries are essential, but you’ll also need to show that the injury occurred while you were working. This can be tricky if there were no witnesses to see the accident happen or if the accident happened over time, such as with a repetitive motion injury.

If your employer denies your workers comp claim due to lack of evidence, it’s important to talk to a lawyer who specializes in such cases.

A worker with his hand caught in a machine, workers compensation concept.

5. Failure to Follow Treatment Instructions

If you fail to follow your doctor’s treatment instructions following your workplace injury, your workers comp claim may be denied.

Your employer has the right to request that you undergo a medical examination by a doctor of their choice. If the examining doctor finds that you have not followed your original treating physician’s orders, your employer may use this as grounds to deny your claim.

6. You Were Under the Influence When the Injury Occurred

If you were under the influence of drugs or alcohol at the time of your injury, your employer may deny your workers comp claim. They may argue that your intoxication was the cause of the accident and that you are therefore not eligible for benefits.

However, there are many cases where an injured worker is denied benefits even though they were not intoxicated at the time of the accident. If you believe that your employer has unfairly denied your claim, you should speak to an Atlanta workers’ compensation lawyer immediately.

7. Your Injury Is Not Severe Enough

Unfortunately, many employers will deny claims for even minor injuries, claiming that the employee is not actually injured or that the injury is not severe enough to warrant compensation.

A lawyer can help you win your case by gathering evidence and medical records to prove that your injury is indeed severe and by arguing that the employer should have taken steps to prevent the accident from happening.

Appealing a Denied Workers Comp Claim

If your workers comp claim has been denied, you may feel like you have no recourse. However, you have the right to appeal the denial and fight for the benefits you deserve.

The first step in appealing a denied workers comp claim is to request a hearing with the state labor department. In Georgia, the State Board of Workers Compensation will review your case and make a decision regarding your appeal. This process can take several weeks or even months, depending on the complexity of your case.

It is important that you gather as much evidence as possible before the hearing. This should include medical records, witness statements, and any other documents that support your claim. Your lawyer can help you organize this evidence and present it in an effective manner at the hearing, as well as cross-examine potential witnesses and argue on your behalf.

Once the hearing is complete, the state labor department will issue its decision in writing. If they find in favor of your claim, you will receive the benefits you are entitled to. If not, you may have to go through another appeals process with higher courts or file a lawsuit against your employer directly.

Contact an Atlanta Workers Comp Lawyer for Help

No matter what steps you take next, having an experienced workers comp attorney in Atlanta by your side can give you peace of mind knowing that everything is being handled correctly throughout the process. Contact us today to schedule your free initial consultation.