Workers' Compensation Denials

Workers' Compensation Denials in Atlanta

Has Your Workers' Compensation Claim Been Denied?

Has you workers' comp claim been denied? If your employer and its Workers' Compensation insurance carrier have denied your claim, and will not reconsider their denial, the only option you really have is to file a Request for Hearing, also called a WC-14. This is a form that starts the litigation process, and it must be filed with the Georgia State Board of Workers' Compensation. There is, however, a limited period of time in which to file your Request for Hearing, which is why it is vital that you take swift legal action and hire an Atlanta workers' compensation lawyer to help.

In some cases, you will be required to testify or provide witness testimony to back up your claim. You may also have to submit to a medical exam by the doctors of the insurance provider. If you want to avoid forfeiting your benefits, a Hearing Request is your best option.

Do you want to file a Hearing Request in your workers' compensation case? Contact Attorney Douglas Kaleita at our firm if you would like to learn more.

Why Was My Workers' Compensation Claim Denied?

Workers' compensation claims can be denied for a number of different reasons. In some cases, you can even receive a partial claim denial, where part of your claim is accepted as being valid but not the entire claim. Do not be mistaken however, you would still need to appeal the partial denial.

The most common reasons for claim denials include the following:

Improper Documentation

If you did not file your injury claim with your employer within a certain time period, then your claim may not be accepted. The reason for exemption could also be that the letter from your doctor/physician does not clearly prove your injury or disability. If they are not able to determine whether your injury was work-related or it was caused by an outside related issue, then they will normally deny the claim. In many cases, it is helpful to seek out further medical evaluation in order to clearly prove that employment was the cause of the injury.

Non Work-Related Injury

You will not be able to recover benefits if your injury did not arise out of an employment-related issue. Some people are under the impression that if they smoke cigarettes on their lunch break while at work and they are later diagnosed with lung cancer, then they can seek workers' comp benefits to pay for treatment and medical care. This is not true.

The Injury Didn't Occur on the Job

This is one of the most common reasons for claim denials. Many people try to get away with workers' compensation fraud by claiming their injury as being work-related, when in reality it was not. If you are injured at a social work function or while commuting to/from work, you are not necessarily guaranteed compensation. If an investigation is run on your claim and they find that your injury actually occurred away from your job and you were not on the clock, then you claim will most likely be denied. For your claim to be seen as valid, your injury would have to be sustained during work hours at the location where you actually perform your duties.

You Were Acting Negligent or Careless

If it is found that you were violating company safety policy when your injury occurred then you may not be entitled to compensation. Some examples of this would be coming to work under the influence of drugs or alcohol, rough housing, horseplay, or practical jokes. If you were playing a practical joke that is not benefiting your employer and it went wrong resulting in your injury, then it may not be considered as being on the job.

You Had a Pre-Existing Condition

If you had an injury or condition that was simply aggravated by your work duties, then it may not be considered as a valid workers' comp claim. For example, if you have carpal tunnel, loss of hearing, or degenerative disease that is age or non-employment related that may not qualify. If you have disease of the lumbar spine and your work injuries aggravate your condition further, causing you severe back pain the claim may still be denied.

Your Injury or Disability Does Not Seem Real

If the insurance carrier does not believe that you are actually injured or disabled then it will not warrant having short term or long term disability benefits. Many times this happens with injured workers' simply take some time off saying that they need time to recover but they did not seek medical treatment. In order for your claim to be valid, you cannot simply lie in bed waiting for your injury to heal. You must get a medical exam in order to verify that your injuries are legitimate and determine the extent of the injury. In some states, your employer will be the one to choose which medical provider you can visit for medical care and treatment- anything else might be seen an unapproved medical provider.

Tried & True Legal Counsel in Workers' Comp Denial Cases

If your workers' compensation claim has been denied by your employer's insurance provider, then it is definitely in your best interests to obtain an experienced workers' comp attorney to help recover the benefits you deserve. Need a lawyer for a workers' compensation denial case in Atlanta? At Kaleita Law Firm, LLC, P.C. we offer a free initial case evaluation to all prospective clients, so you can sit down and discuss your case without any commitment or financial obligation.

When you work with our firm, there is no fee unless we win your case and successfully recover benefits and compensation on your behalf. If you or a loved one has been injured at work, it is crucial that you learn about all your options. If your benefits have been denied, we can help you every step of the way throughout the process.

Contact our firm today to get started!


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