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What to do if your workers' compensation claim is denied

Your workplace injury required time in the emergency room or urgent care facility. Perhaps you broke a bone, needed stitches or had to get an MRI for a head injury. Maybe your accident was more serious, and an ambulance transported you to the hospital where doctors admitted you for treatment and observation.

More than anything, you are eager to get back to work. Every day of your recovery is a day without pay, and the medical bills are beginning to arrive in the mail. You are counting on workers' compensation to cover those bills and make up for the days you were off work. Then you receive notification that your employer's insurance has denied your claim. What happens next?

Why was my claim denied?

There are numerous reasons why workers' compensation providers may deny your claim. You should find an explanation in the letter they sent you. Some of the most common reasons for denial include the following:

  • Your injury did not occur during your normal work activities or was the result of horseplay.
  • You missed the deadline for reporting your injury to your supervisor.
  • You did not apply for your claim within the time limit.
  • You did not receive medical treatment for your injury or follow through with the treatment your doctor ordered.
  • You did not submit adequate evidence to prove your injury occurred on the job.
  • Your employer disagrees that your injury is eligible for coverage.

If the reason for the denial does not make sense to you, meet with your employer to discuss it. There is a chance the refusal of benefits is a mistake that is easily rectified. However, if your meeting does not easily resolve the situation, you may need to file an appeal. You will have a limited window in which to begin the process. In Georgia, that deadline is 20 days from your denial.

Don't handle this alone

An appeal of a denied workers' compensation claim is complicated. First, you will have to address the reasons stated for the denial of your claim. For example, you may need to gather additional documentation, medical reports or other evidence. You may have to find witnesses to testify on your behalf.

A workers' compensation appeal is typically presented before a judge of administrative law. In fact, you may also have to take your case through several levels of appeals before achieving a final ruling. For the best results, you may wish to seek the assistance of an attorney with experience in matters of workers' compensation appeals before administrative courts.

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