What can I do if my Georgia workers’ compensation is denied?

People who have been denied workers’ compensation benefits in Georgia should be aware of their options.

Under Georgia law, any business that has three or more workers, including part-time workers, is required to carry workers' compensation insurance. When someone experiences an on-the-job injury, he or she can apply for workers' compensation benefits, which can cover medical expenses and replace missed income.

Unfortunately, people in Georgia may find that their application for benefits has been denied. It is important to know why this can happen and what to do in the event that it does.

Why benefits may be denied

According to the Georgia State Board of Workers' Compensation, an injury at work should be reported to the victim's supervisor immediately. Failing to do so could result in losing benefits. There are several deadlines that an employee should be aware of, such as the following:

  • An incident should be reported to an employer within 30 days.
  • The injured has one year from the date of the incident to file a workers' compensation claim.
  • People who suffer an occupational disease have one year from the date of when they knew or should have known about the condition to file a claim.

Missing these deadlines is an easy way to miss out on benefits. However, a claim could also be rejected due to incomplete paperwork, a discrepancy between the accident report and a medical record or the insurance company does not believe the injury occurred as the result of employment. Lastly, someone who is found to have been under the influence of drugs or alcohol will likely be excluded from receiving benefits.

Next steps

Someone whose claim has been denied will receive notice of the denial along with an explanation. After that occurs, the injured may request a hearing before the SBWC. The organization points out that the employee can either represent him- or herself, or he or she can hire an attorney. The SBWC notes that having an attorney can help someone present a case properly.

An administrative law judge will preside over the hearing, during which both sides will be able to present an argument. The judge will then make a decision regarding what, if any, benefits may be received.

The option of mediation

The SBWC does give injured employees the opportunity to avoid a hearing and instead participate in mediation. During this process, a neutral third party will try to help the employee and the insurance company reach an agreement. This process is much less formal than a hearing. If an agreement cannot be reached, the employee may request a hearing before a judge.

Filing an appeal

Lastly, a Georgia worker who has been denied workers' compensation benefits can appeal the administrative law judge's decision to the Appellate Division of the SBWC. The division will review the case and make a decision based on the information presented.

Anyone who has concerns about this issue should consult with an attorney.