An injury that keeps you from working can be devastating to your finances, which is why it’s so important that injured workers are able to collect benefits as soon as possible. If your employer has disputed your claim, however, you may have no way to access these benefits.
Employers have insurance companies with legal teams representing their interests. If your claim has been denied, you need to make sure you also have a dedicated Lawrenceville workers’ compensation attorney on your side. We are knowledgeable in Georgia workers’ comp law and can resolve your Lawrenceville workers’ compensation dispute.
Call 470-518-5026 to schedule your free consultation.
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Causes of Lawrenceville Workers’ Compensation Disputes
While some workers’ compensation claims are denied for valid reasons, there are also legitimate claims that are denied. Some of the most common causes of disputes include:
Employment Status
In Georgia, you’re entitled to workers’ comp benefits even if you were hurt on your first day on the job. However, these benefits are only available to workers that are classified as employees. Benefits cannot be collected by contract workers.
However, contract workers may still be eligible for benefits if they are misclassified. If a worker is labeled as a contractor but is actually a misclassified employee, they can still file for workers’ comp, and they may be able to receive other benefits in addition to that.
Outside the Scope of Employment
In some cases, it’s clear that an injury occurred on the job. In other cases, the line could be blurred. Can a worker claim benefits if they were injured while attending a company party or while picking up lunch for their co-workers? Claims can also be denied for this reason if a worker was engaging in reckless behavior that was outside their job duties, like fighting on the job.
An injury doesn’t always need to happen in the workplace to be covered under workers’ compensation. Work from home injuries and injuries suffered while traveling for work events should both be covered. If an employer has denied your claim for this reason, you’ll want to have your case assessed by an attorney.
Lack of Causation
If your injury went unwitnessed, your employer may try to argue that your injury was not caused by your work duties. It’s also common to see these types of disputes for repetitive strain injuries and other injuries that occurred over time. Medical records can be used to establish that the injury is work-related.
Missed Deadline
Georgia employees are required to report an injury promptly if they plan on filing for workers’ comp. Injuries should be reported within 30 days. Failure to report an injury within that timeline can lead to a claim being denied outright.
There are a number of reasons that a worker may fail to report an injury in a timely manner. For example, if your injury was witnessed by a supervisor, you may have assumed that it was unnecessary to formally report your injury. If your employer did not inform you of their workers’ comp policies, you may not have been familiar with reporting procedures.
It can be difficult to file a successful claim after missing deadlines, but it isn’t impossible. If there is a valid reason for missing a deadline, an experienced workers’ comp attorney may be able to help you come up with an appeal strategy.
Inadequate Information
After reporting an injury to your employer, you will be asked to complete form WC-14. If important information is missing from this form, such as details about the accident, your claim could be disputed. It’s best to be as thorough as possible when completing this form.
What to Do If Your Workers’ Comp Claim Is Denied in Georgia
If you have been denied benefits, you can request a hearing in front of an administrative law judge. You can request a hearing by contacting the Georgia State Board of Workers’ Compensation. The time limit to file is one year, but an appeal is more likely to be successful if it is filed quickly.
There are no jury trials for workers’ comp appeals in Georgia. Only the judge overseeing the hearing will be able to rule on the compensability of the claim. Depending on their ruling, a judge may order that a worker should receive benefits, including retroactive benefits.
It’s important to make a strong case when appealing a denial in front of a judge, which is why you’ll want to contact a workers’ comp attorney before your hearing. A lawyer can look at your case, determine if the denial was valid, and argue on your behalf when you appeal your claim.
Types of Workers’ Compensation Disputes
Not only can workers’ comp claims be denied for a number of reasons, but there are different types of disputes. The claim could be fully denied by the insurance company, or a portion of the claim could be disputed. Claims that are wholly denied are typically referred to as claim disputes.
When an insurance company argues about the treatment that an injured worker is receiving or about a portion of their injury, it is generally referred to as a medical dispute. These types of disputes can be appealed, but it may also be possible to resolve the issue in mediation with the help of a lawyer.
Workers’ Compensation Dispute and Appeals Process in Georgia
The Administrative Law Judge that hears your appealing does not have to make a ruling immediately. The judge has 30 days to review the facts and make a decision. Both parties have 20 days to appeal this ruling. If the judge decides in the employee’s favor, and the insurance company does not appeal that decision, the employee will be awarded benefits, including retroactive benefits, within 20 days.
If the judge’s ruling is appealed, the case will be sent to the Appellate Division. The Appellate Division may make a decision about the judge’s ruling, or they may send the case back to an Administrative Law Judge. Appellate Division rulings can be appealed to the Superior Court, and Superior Court rulings can be appealed to the Georgia Court of Appeals.
Hire the Best Lawyers for Your Lawrenceville Workers’ Compensation Dispute
Even if your claim has been disputed or denied, you may still be able to access benefits. Workers’ Compensation Lawyers Atlanta will review your case for free and can give you advice on how you should proceed. Call us at 470-518-5026 if you want to find out more about appealing your claim.
Your initial consultation is free, and you pay no legal fees unless we recover benefits for you!
