Workers compensation was set up to pay benefits to you when you suffer an injury at work. These benefits basically cover your medical costs plus time that you miss from work.
Insurance companies do not always pay benefits when they should. Sometimes, they deny part or all of your case.
Usually, the insurance company denies your case by sending you a letter or form saying that your case has been denied. The insurance company should file the official denial on a Form WC-1 or Form WC-3.
This form should notify you of the reason the insurance company is denying your case. Unfortunately, it will often just give a general reason for denial like one of the following:
- No accident arising out of and in the course of employment
- Willful misconduct
- Idiopathic injury
This can be very confusing because the insurance company does not spell out the exact reason they are denying your case. This can make it very difficult for you to know what information you need to provide them to get them to change their minds.
Sometimes, the insurance company does not send you a letter or a form when they deny your case. They may simply deny your case in a phone call. They might even just not ever give you an answer.
In most instances, Georgia law gives the insurance company 21 days to decide whether they are going to accept or deny your case. If you have not gotten an answer from the insurance company within 21 days, then you may need to treat things as if your case has been denied.
Why was my workers compensation case denied?
There are a number of different reasons that your case could have been denied by the insurance company. Some common reasons that insurance companies deny cases include:
- They do not believe that you are injured
- They believe you are injured but do not believe that your injury was caused by the work you did
- A positive drug or alcohol test after your injury
- They claim that you were not “on the clock” when the injury occurred
- Your injury was caused by violation of a work or safety rule
I wish that the denial form that the insurance company files denying your case required them to be more specific about their denial. This would make it easier to straighten things out and get wrongful denials reversed.
Can I still get workers compensation benefits after my case has been denied?
Yes, you can still get benefits. But, you will have to get the insurance company’s denial reversed in order to receive workers compensation benefits unless the insurance company has only partially denied your case.
What can I do when my workers compensation case is denied?
There are a couple of potential ways that you can contest the insurance company’s denial of your case. The specific facts of your case will help determine which is the best option for you.
One way that you can contest the denial of your case is by contacting the insurance company and asking them to reconsider. To get them to reconsider, you will need to figure out why they denied your case.
If you know why they denied your case, you or an attorney may be able to provide them with additional evidence that would have them change your opinion. If so, then you should start receiving workers compensation benefits.
Another approach to contest the denial is to request a hearing. Under Georgia law, you can file a hearing request with the Georgia State Board of Workers’ Compensation.
You request that hearing by filing a document called a Form WC-14. On that form, you or your attorney can indicate what benefits you are requesting.
After the form is filed, the State Board of Workers’ Compensation will schedule a hearing date for you. It does usually take a while to get to court as there are several steps you usually have to go through. If you want to know more information about the workers compensation court process, this article discusses it in more detail.
Do I have to have a workers compensation attorney to contest my denial?
No. You do not have to have an attorney to fight a workers compensation denial. But, I would certainly recommend that you speak with a workers compensation attorney before deciding to move forward without an attorney representing you.
Workers compensation attorneys generally specialize in workers compensation cases. They will be able to discuss the best approach to take in fighting the insurance company’s denial.
Having a conversation with an attorney usually gives you the information you need to make a decision about how to move forward. This article provides you with a little bit more information about talking to me or another workers compensation attorney at our firm about your workers compensation case.