Top 9 reasons why your workers’ compensation claim could be denied in Georgia
Workers’ compensation is a social contract between employers and employees in Georgia. That is to say, this system has long been a part of the fabric of the way that Georgia operates, and employees generally feel safer when they work for a company that offers this benefit to them. After all, we all want to feel safe when we go to work somewhere.
When you sustain an injury while on the job, you might think that your eligibility for workers’ compensation benefits are all but assured. However, there are times when even strong claims receive denials, whether due to procedural errors or other issues that are not your fault.
When workers’ compensation claims are sometimes denied, much to the surprise and anger of the injured workers, it’s vital that you familiarize yourself with some of the most common reasons and take the steps necessary to boost your claim’s chances of success.
If your workers’ comp application has been denied, reach out to our team at WPMH Legal today so we can discuss your options. Below, we’ll explore a few possible reasons why workers’ compensation claims are frequently denied in Georgia.
Reason #1: Failure to seek prompt medical attention
Injuries that qualify for workers’ compensation are generally quite serious in nature and require you to seek medical attention as soon as possible. Those who fail to get the proper medical attention that they require not only jeopardize their own health but also their chance to file for a workers’ compensation claim.
Waiting for an extended period of time to obtain medical care following an accidental injury leaves open the possibility that the employer or insurance carrier will assert that the harm occurred due to something besides a workplace incident.
Your employer should have information easily available to you regarding the contact information for an authorized physician. This is the physician that you should go to if you are injured on the job, not your personal doctor.
In extreme situations, you may need to go to the emergency room right away for the treatment of catastrophic injuries. Don’t worry though, as this doesn’t disqualify you from filing a workers’ compensation claim down the road.
Try to collect all of the documentation that you can about your injury and the treatments that you received as soon as possible.
Reason #2: Failure to promptly report an injury to your employer
Those who don’t report a workplace injury will have trouble seeking workers’ compensation benefits for that injury. The injury must be officially noted so that you can figure out what steps you need to take next.
Sometimes people feel like an injury is too minor to even bother reporting, but that is a myth. Any workers’ comp attorney will tell you that all workplace injuries should be reported, no matter how minor they seem at the time.
Some employees are worried that their employer will get mad at them for reporting an injury and that something bad may happen at work as a result. Georgia law is very specific: an employer is not legally allowed to retaliate against an employee for filing a report of an injury at work. They have to treat you just the same as they would anyone else.
Don’t run away from filing an injury report out of fear. This could come back to haunt you down the road.
Many workers’ compensation claims are susceptible to denial simply because the injured party is not sufficiently prompt in reporting their injuries. Time is of the essence in securing payment of benefits through this system of compensation, and delays in submitting a claim will increase the chances of a denial. Therefore, it’s best to act quickly following the accident.
Reason #3: Failure to take or pass a drug test
Another common reason why workers’ compensation claims are denied is that the employee was under the influence of drugs or alcohol at the time that the injury occurred. Most workplace injuries that occur while someone is under the influence do not qualify for a workers’ compensation payout, but there are exceptions.
Your employer is allowed to ask you to submit to a drug and/or alcohol screening following a workplace accident. You may refuse to take the test, but doing so will likely put upon you a presumption of guilt.
Those who take the test and fail will face an uphill battle to win their case as this could severely reduce or eliminate the responsibility of your employer to have prevented whatever accident caused your injury. In such cases, it’s imperative that you meet with an attorney to determine your legal options and rights.
Reason #4: A pre-existing injury or condition
Some workers’ compensation claims are subject to denial when an employee neglects to disclose prior injuries. This is because if a similar injury is ultimately suffered on the job, an employer or insurer may use that failure to disclose as a means to try and refuse payment. However, it’s important to realize that injuries that you already have prior to being employed that are then aggravated or worsened by the work may still qualify for benefits under Georgia’s workers’ compensation system.
It is a delicate balancing act between reporting the injuries that you know you have and trying to get a job working somewhere that may cause those injuries to get worse. No one wants to make their injuries worse, and employers certainly don’t want to be on the hook for that, but it is still best to report these issues as soon as possible.
The more that your potential employer knows, the better these cases can resolve in your favor. Understand that it is a requirement if you ever need to file for workers’ compensation, and try to get as much information out there as possible.
Reason #5: Falling victim to an employer’s delay tactics
Employees who fall victim to their employers’ delay tactics following an injury accident also run the risk of having their claim denied. There is no need to wait to speak to a lawyer and immediately file a workers’ compensation claim as soon as an injury occurs.
Reason #6: No one else witnessed the work accident
Another issue is when the event in question wasn’t witnessed by anyone other than the claimant, and then the employer lodges a dispute. Gathering key evidence is a way to get around this problem, and that is why the help of an attorney is crucial.
Reason #7: Injured worker has a prior record
Claims can also be vulnerable to denial when an employer attempts to raise the injured employee’s own past conduct as a way to discredit their explanation of what occured.
For instance, a worker’s criminal record may be mentioned by an employer in order to cast doubt on their truthfulness. Or if the worker has filed past workers’ compensation claims that are similar, the insurer may try to argue that the employee is being dishonest about their accident or intentionally caused it to earn money.
Injured parties must keep in mind, however, that such information has no relevance to whether a claim is valid.
Reason #8: Accident occurred outside of work
Claims can also be denied if an employer claims that the injury at issue may have occurred someplace other than at the workplace. For instance, when an employer has a heart attack while at work, an employer may attempt to argue that the incident didn’t result from conditions at the workplace.
Reason #9: Lack of workers’ compensation policy
Finally, an employer may work hard to ensure that a claim is denied simply because they don’t have a workers’ compensation insurance policy in place, despite their legal requirement to do so. Without such coverage, an employer may be hard pressed to pay for the cost of injuries sustained.
Provided the employer has no less than 3 employees, state workers’ compensation laws apply. If you have suffered harm on the job, and your employer lacks insurance, there may be remedies an attorney can still help you pursue.
Get help fighting your workers’ compensation denial
If your claim for workers’ compensation benefits is denied, it can be extremely difficult to obtain a reversal of that decision without the aid of a seasoned attorney. A work injury lawyer with a track record of succeeding in the realm of workers’ compensation can work to present evidence and arguments designed to maximize your chances of securing the approval you need.
Always contact an experienced workers’ comp attorney as soon as possible if you are injured at work. For Georgia residents, reach out to the law firm of Westmoreland, Patterson, Moseley & Hinson. We can take on your case right away and start to remove some of the stress you have about your injury.