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Can I Appeal a Workers Compensation Denial?4 minute read

When you get injured on the job, you need medical treatment and income to recover from your injury.  Georgia workers compensation pays these benefits after you suffer a workers compensation injury.

But, what do you do if the insurance company denies your workers compensation claim? When the insurance company denies your claim, they will refuse to pay for your medical treatment.  They will also refuse to pay you lost wages for the time you are unable to work.

If you got hurt on the job, you need to understand how you can fight this denial to receive the benefits you should.  This article discusses what you can do if the workers compensation insurance company denies your claim.

Denied work injuryHow do I know the insurance company denied my claim?

When the insurance company denies your claim, you will likely find out a couple of different ways.  The insurance adjuster or case manager may tell you in a conversation over the phone or may send you a letter or an email.

Sometimes, the insurance company will also send you a Form WC-1 or Form WC-3 indicating that your claim is being “controverted”.  Controverted is really just a fancy word for denied.  If you receive a form telling you that your claim has been “controverted”, then you should know that your claim (or at least part of it) is being denied.

The other thing that can happen is that the insurance company just never pays you anything.  In this situation, the insurance company may deny your claim without ever telling you.  You really only know that this happens because you never start receiving any workers compensation benefits.

Can I appeal the denial of my workers compensation claim?

Yes.  You can file an appeal when the insurance company denies your claim.

How can I appeal the denial of my workers compensation claim?

There are a couple of different ways that you can fight the denial of your claim.  The best way to fight the denial depends on the particular facts of your situation.

The first way to fight the denial is to communicate with the insurance company to try to get them to reverse their denial and accept your claim.  Often times, you or an attorney representing you can provide information to the insurance company to show that the denial is incorrect.  This can help when the insurance company has incorrect or incomplete information.

In this situation, it is important to understand the reason or reasons why the insurance company has denied your claim.  Understanding this can help you or an attorney representing you provide the information needed to get the insurance company to reverse the denial.

Other times though, the insurance company will not reverse the denial even when provided with additional information.  In this situation, you can file an official appeal of the insurance company’s denial and get a hearing in front of a workers compensation judge.  This is done by filing a Form WC-14 to request a hearing.

Appeal signDo I have to hire an attorney to appeal my denial?

No.  You do not have to hire an attorney to appeal a denial.  You can appeal the denial of your claim without hiring an attorney.

That being said, I would recommend that you speak with a workers compensation attorney if your claim has been denied.  The insurance company will have an attorney they hire to represent them.  If you do not understand the legal rules of fighting the denial, you can end up losing your case on a legal technicality or by failing to properly present the evidence to prove your case.

A good attorney will let you know whether you need to get the attorney involved.  Also, most workers compensation attorneys work on contingency fee contracts which means that you only pay attorney’s fees to the attorney if they win your case.

How long do I have to appeal the denial of my claim?

It depends on when the denial occurred and whether you were paid any workers compensation benefits prior to the denial.  But, it is important to understand that there are deadlines which apply to the filing of your claim.  These deadlines are called statutes of limitations.

If you do not file a request for a hearing on time, these deadlines can cause you to lose your case even if you have the evidence to prove that you should win your claim.  So, be sure not to wait too long after receiving the denial to decide what you are going to do about filing an appeal.  Again, the best thing to do is to reach out to a workers compensation attorney for a free consultation to get answers to your questions.

What if I have other questions about workers compensation?

Georgia’s workers compensation system can be very confusing.  You have to worry about getting the treatment you need and paying your bills while also worrying about not missing any deadlines that could cause you to lose your right to receive workers compensation benefits.

If you have questions, I would recommend that you try to get answers.  To find out more about how to schedule a time to talk to me about your workers compensation questions, just read this short article.

Jason Perkins is an attorney who specializes in representing injured workers.  He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families.

To be notified of Jason’s new workers compensation videos, subscribe to his Georgia Workers Compensation Video Series channel on YouTube by clicking the subscribe button below.

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