If you’ve been injured at work in Georgia and your workers’ compensation claim was denied, you have the legal right to appeal the decision. But appealing a denial isn’t just a matter of filing a form. The process is time-sensitive, requires specific documentation, and often involves multiple stages, including formal hearings and legal arguments. A missed deadline or an incomplete record can cost you access to medical care and wage benefits.
At Perkins Studdard, we work with injured workers across Georgia to challenge wrongful denials and secure the compensation they’re entitled to under the law. Whether your employer disputes that the injury was work-related or the insurer claims you didn’t follow the right procedure, we know how to build a case that holds up during the appeal process.
Why Was My Workers’ Comp Claim Denied?
The first step in appealing a denial is knowing why your claim was rejected. Workers’ compensation claims in Georgia are denied for several common reasons. Some involve legal issues, while others are based on medical documentation or employer challenges.
- The Injury Was Not Reported On Time: Georgia law requires that you report a workplace injury to your employer within 30 days. While there are some limited exceptions, failing to report your injury within 30 days can lead to a claim denial, even if the injury is legitimate.
- The Employer Disputes the Claim: Your employer may deny that the injury occurred on the job or claim that it was caused by something outside of work. This is one of the most common reasons for denials.
- Lack of Medical Evidence: If clear medical records do not support your work-related injury, or if there is a delay in seeking treatment, your claim can be denied because you have insufficient proof.
- Injury Did Not Arise Out of Employment: Under Georgia law, your injury must arise out of and in the course of employment. The claim may be challenged if your injury happened during a break, on your commute, or while doing something outside your job duties.
- Willful Misconduct: Certain actions which count as willful misconduct can result in your claim being denied. Common situations include violation of safety rules, intoxication, and violations of certain laws.
- Pre-existing Conditions: Insurance companies often argue that your injury is due to a prior medical condition rather than a workplace accident. While this can complicate your case, it does not automatically bar you from receiving workers’ comp benefits.
The insurance company handling your claim should file a formal letter denying your claim on a Form WC-1 or WC-3, but this may not happen. Even if you do not receive a formal claim denial, you still need to know that there are deadlines to pursue your workers’ compensation claim in Georgia.
Can I Appeal a Denial of My Workers’ Compensation Claim?
Yes. If your workers’ compensation claim is denied in Georgia, you have the right to appeal that denial with the State Board of Workers’ Compensation (SBWC). This process begins with requesting a hearing before an Administrative Law Judge (ALJ) and can involve multiple steps if the case moves beyond the initial hearing.
Step 1: Request a Hearing by Filing Form WC-14
To begin your appeal, you must file Form WC-14 with the Georgia State Board of Workers’ Compensation. This form requests a formal hearing before a judge. You must also send a copy to your employer and your employer’s workers’ comp insurer.
There are deadlines known as statutes of limitation that apply to appealing your denial. In most cases, the Form WC-14 must be filed within one year of the date of your accident. There are some situations which extend this deadline, but it’s in your best interest to act quickly after a denial to avoid delays in getting benefits.
Step 2: Discovery and Pre-Hearing Preparation
Once your hearing is scheduled, both sides will begin gathering evidence. This phase is known as discovery and may include:
- Medical records and reports
- Depositions of doctors and witnesses
- Interrogatories, requests to produce, and other formal written discovery
- Employment records
- Surveillance footage
The insurance carrier may also request that you attend one or more independent medical examinations (IME) with a doctor of their choosing. An experienced workers’ compensation attorney can help you prepare and respond appropriately.
Step 3: Attend the Administrative Hearing
Your hearing will be held in front of a workers’ compensation Administrative Law Judge. It is a formal legal proceeding, similar to a court trial.
During the hearing, you can present medical evidence and testimony and your workers’ compensation lawyer may question witnesses. The employer and insurer will present their side and both sides may call medical experts. Legal rules apply regarding what evidence can be presented and how it must be presented. Both sides can object to evidence presented when it does not follow the
The judge will not issue a decision on the same day. Workers’ compensation lawyers often submit written arguments after the hearing called briefs. After reviewing the evidence and testimony as well as any briefs filed, the judge will issue a written ruling, often within 30 to 60 days of the hearing date. .
Step 4: If Denied Again, Appeal to the Appellate Division
If the judge rules against you, you have the right to appeal to the Appellate Division of the State Board of Workers’ Compensation. You must file this appeal within 20 days of the date of the judge’s decision. The Appellate Division reviews the evidence from the initial hearing and the arguments about why the judge’s decision was wrong. The Appellate Division then either affirms, reverses, or modifies the initial decision.
Step 5: Further Appeal to the Georgia Courts
If the Appellate Division rules against you, you can appeal to the Superior Court. This step must be taken within 20 days of the decision. From there, your case could move up to the Georgia Court of Appeals or even the Georgia Supreme Court if legal issues are involved. Court-level appeals are rare, as most cases are resolved at the ALJ or Appellate Division level.
What Evidence Makes a Workers’ Comp Appeal Stronger?
Winning a workers’ compensation case in Georgia depends on presenting clear, convincing evidence and legal arguments. This may include:
- Detailed medical records from doctors and other medical providers
- A formal written opinion from your doctor explaining how the injury is job-related
- Testimony from co-workers, supervisors, and other people with knowledge of the work injury
- Photographs or documentation of the workplace hazard
- Testimony regarding your injury and your job duties, including the physical requirements of your job
If the workers’ compensation insurance company sends you to an IME, that doctor’s report may also be used as evidence, but it often favors the insurer. Your attorney may work to rebut that report with other medical opinions.
Can You Work While Your Case Is on Appeal?
That depends on your condition and your doctor’s recommendations. If you are receiving or requesting workers’ compensation wage loss benefits, that can limit your ability to work. If you are not receiving or requesting wage loss benefits, you may be legally entitled to work but it still may not be medically advisable to work depending on your doctor’s recommendations.
If your employer offers light-duty work and your doctor approves, you may need to return. Keep in mind that your income may be reduced, and you may still be entitled to partial wage benefits. Document everything and talk to your workers’ compensation attorney first because the rules about returning to work can be tricky.
How Long Does the Workers’ Comp Appeal Process Take in Georgia?
The timeline varies depending on the details of your case and whether the appeal goes beyond the first hearing. Generally speaking, the first hearing is scheduled within 30 to 90 days after filing Form WC-14. But, hearings are almost always rescheduled at least once and sometimes many times before the hearing actually takes place. Delays are common if medical disputes or witness scheduling issues arise.
A decision from the ALJ typically comes within 30 to 60 days after the hearing. Appeals to the Appellate Division usually take four to six months. Further appeals to the court system add several more months or even years. In total, a full appeal can take anywhere from six months to a few years.
Do You Need a Lawyer to Appeal a Workers’ Comp Denial?
Technically, you can represent yourself. However, going up against an insurance company and their legal team without an experienced workers’ compensation lawyer puts you at a serious disadvantage.
A Georgia workers’ comp attorney can:
- Review the reasons for your denial and explain your legal options
- Collect the right medical reports and factual evidence
- Represent you at hearings and appeals
- Cross-examine the worker’s compensation carrier’s medical experts
- Challenge employer defenses and push for fair compensation
- Help you understand settlement options and negotiate terms
At Perkins Studdard, we’ve helped injured workers across Georgia challenge denials and win the benefits they need to recover and move forward.
What Types of Workers’ Compensation Benefits Are at Stake?
If your workers’ comp claim is approved on a successful appeal, you may be entitled to the following benefits for injured workers:
- Medical treatment is paid for by the insurance company
- Temporary total disability (TTD) benefits if you cannot work at all
- Temporary partial disability (TPD) if you return to work at reduced wages
- Permanent partial disability (PPD) benefits based on lasting impairment
- Mileage reimbursement for travel to and from medical appointments
- Rehabilitation services in certain limited cases
These benefits for workplace injuries can make a major difference in your ability to heal and support your family. The sooner you reach out to an experienced attorney, the sooner you can overcome any denials and better support your recovery.
Denied Claim? Get Help from a Georgia Workers’ Comp Lawyer
A denied workers’ compensation claim can feel like a dead end, but it’s not the final word. You have the right to appeal, and legal guidance from an experienced lawyer can turn the case around.
At Perkins Studdard, we help injured workers across Georgia take on denied claims and fight for the benefits they deserve. We know the system, we know the law, and we know how to win. If your claim was denied, call us today or fill out our online form to schedule a free consultation with a workers’ comp lawyer. We’ll review your case, explain your options, and help you win the benefits you’ve earned.
