If you’ve suffered a workplace injury, you may assume that collecting benefits will be a relatively straightforward process. Sadly, this isn’t always the case. If you’re struggling to collect benefits because of a dispute, your best option is to entrust your case to our team at Workers’ Compensation Lawyers Coalition. We’ve successfully resolved many workers’ comp disputes in Forest Park, GA, and have helped workers collect compensation for their injuries.
Call 470-518-5026 or contact us online to schedule a free case review today!
Table of Contents
Causes of Workers’ Comp Disputes in Forest Park, GA
Since claims can be disputed or denied for a number of reasons, your safest option is to hire an experienced attorney as you prepare to file a claim. Lawyers that handle workers’ comp claims are very familiar with common disputes, and your attorney can take steps to reduce the likelihood of denial.
Here are some of the common causes of workers’ compensation disputes:
Disputed Employment Status
In Georgia, only workers that are classified as employees have access to workers’ compensation benefits. Freelancers and independent contractors are not eligible. However, if a worker is wrongfully classified as an independent contractor, they may still be able to receive benefits.
Injury Was Outside Scope of Employment
It’s also common for insurance companies to argue that the injury occurred outside the scope of employment. This injury is especially common for cases involving pre-existing conditions. Insurance companies can use pre-existing conditions to dispute claims even if the worker was unaware of the injury.
Lack of Causation
Lack of causation is another common argument in cases that involve pre-existing conditions. Insurers may argue that the injury was caused by the condition rather than the work itself and that the injury would have occurred regardless. It’s important to be examined by a physician immediately after an injury so that the cause of the injury can be established by a professional.
Reporting Accident Too Late
Georgia law requires that an accident be reported within 30 days. If you do not report your injury and file a claim within the appropriate time limit, you may lose out on the opportunity to collect benefits. While the deadline to file can be extended under some circumstances, claims that are denied for this reason are rarely overturned.
Incomplete Information
If you only provide limited information when you file your workers’ compensation claim, the state board may not be able to determine if you are entitled to benefits. In these cases, your claim will be denied due to inadequate information. It’s important to be as detailed as possible when completing paperwork related to your accident.
What to Do if Your Workers’ Comp Claim Is Denied in Georgia
Whether your claim was denied as a whole or a specific aspect of your claim was rejected, you have the right to appeal this decision. If you choose to appeal your claim, your first step will be to request that your case be heard by an administrative law judge. You can request a hearing through the State Board of Workers’ Compensation.
After your request has been submitted, a date for the hearing will be scheduled. There will be a period of discovery in which both you and the insurance company can request documents and information from each other. Georgia law states that a hearing must be held within 90 days of the date the request was received.
The administrative law judge that hears the case will not be able to issue a settlement to either party. Instead, the judge will assess the claim and determine if it is compensable. If the judge rules that your injury does qualify for benefits, you may be eligible to receive retroactive benefits.
If the administrative judge does not rule in your favor, you have the option of appealing that ruling as well. If you do choose to appeal the case, it will be heard by the State Board of Workers’ Compensation’s appellate division. The appellate division can overturn, affirm, or amend the decision from the administrative judge. The case may also be sent back to an administrative judge.
Successfully appealing a denied claim can be challenging, which is why it’s crucial to contact an attorney if you plan on appealing your case. A lawyer can determine why your claim was denied and can build a strong argument to present to the judge.
Types of Workers’ Compensation Disputes
There are two primary categories of workers’ compensation disputes. Medical disputes occur when an insurer and an injured worker disagree about the worker’s medical care. These disputes could involve a change of physician, a refusal to cover certain types of rehabilitation services or disagreements about whether a patient has achieved Maximum Medical Improvement.
Claim disputes are disagreements about a claim itself. An insurer may dispute parts of the claim or may believe that the claim should be denied outright. In some cases, a claim may go into mediation before it is heard before a judge.
Workers’ Compensation Dispute and Appeals Process in Georgia
When a claim is disputed or denied, it is possible to resolve the dispute through mediation or through the appeals process. Although you are not required to obtain legal counsel before appealing benefits denial, it is strongly recommended.
If an appeal is denied, that appeal can be brought before a higher authority. Appeals are initially heard by an administrative law judge. If benefits are denied by the judge, that decision can be appealed to the Appellate Division of the State Board of Workers’ Compensation. The Appellate Division consists of three members that will review the previous hearing. No new evidence can be submitted at this time.
If the Appellate Division affirms the previous ruling, that decision can be appealed to the Georgia Superior Court. If that decision is denied, it can be appealed to the Georgia Court of Appeals. The odds of having a decision overturned decrease at each new stage of the appeals process.
Get Help With Workers’ Comp Disputes in Forest Park, GA
It’s not unusual for workers’ compensation claims to be wrongfully disputed or denied. Unfortunately, overturning these decisions isn’t always a simple process. If you are struggling to collect benefits for your claim, Workers’ Compensation Lawyers Coalition can take over this fight for you. Just reach out to us at 470-518-5026 to get started.
