Did you receive a Notice to Controvert form from your employer or their insurance company?
Don’t let them have the final word. We can examine your claim and explain your legal options.
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Macon, GA 31201-8242
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After eagerly awaiting a response for weeks (maybe months) regarding your workers’ comp claim, you finally get something in the mail from your employer’s insurance company. You tear open the document and see “WC-3 Notice to Controvert” printed at the top of the paper. What follows is a stream of complicated insurance jargon and references to Georgia statutes that’s hard to understand.
What is a notice to “controvert”? What does it all mean?
If you’ve received State Board Form WC-3, you should know that it basically means that your employer’s insurance company is contesting your work injury claim and refusing to pay. For whatever reason, they aren’t going to make this process easy for you and you should consult with a knowledgeable lawyer in your area as soon as possible to learn about your options.
Below, we’ll explain a little more about what a controverted claim means for you and how to move forward. But first and foremost, we recommend reaching out to one of our experienced workers’ compensation attorneys immediately. Don’t accept the insurer’s ruling as the end of the road; in fact, it’s only the beginning.
At the law firm of Westmoreland, Patterson, Moseley & Hinson, our attorneys have helped fight back against controverted claims and forced insurers to reexamine their evaluations for the last 50 years. We’ve represented hundreds of injured workers in Macon-Bibb County and throughout the state of Georgia. We can help you take the right steps and negotiate on your behalf. We have the experience, knowledge and commitment to see your claim through to the end.
What does “controverted” mean?
The word “controvert” is defined as a verb meaning “to deny the truth of something.” In law, specifically workers’ compensation and personal injury law, a controverted case is when an injured plaintiff’s claim is argued, denied or contested by the employer or an insurance company.
In essence, it means that for whatever reason, the employer or their insurance company has chosen to not pay for your medical treatment. Instead, they have decided to challenge their liability and will not pay unless ordered to by an Administrative Law Judge (ALJ).
Your rights and responsibilities
Just because your workers’ compensation claim was “controverted” doesn’t mean that you are out of options. This simply means that your employer or an insurance company has chosen to contest or deny your claim and will not provide medical benefits until proven otherwise.
According to Georgia’s Workers’ Compensation Act, once a claim has been controverted, the injured individual may choose to treat with a physician of his or her choice. Per Board Rule 201b: “the Employer/Insurer cannot restrict treatment of the Employee to the panel of physicians, conformed panel of physicians, or WC/MCO when the claim has been controverted.”
Though you have greater freedom to select a doctor of your own choosing if your claim is controverted, the downside is that you’re left footing the bill. Thus, you may need to enlist the help of a qualified workers’ comp attorney near you to challenge the ruling and pursue compensation through the insurance carrier or employer.
Proving that the employer or insurer is wrong and finding the right doctor to treat your injuries or illness are both intimidating and formidable tasks. At the law firm of Westmoreland, Patterson, Moseley & Hinson, we can help secure the best possible outcome for you and we’re not afraid to go head-to-head with insurance companies to get the benefits you deserve.
Common insurance tactics to delay benefits
Even if the insurance company is unable to deny or controvert your workers’ compensation claim outright, they will often tell the claimant that they are “investigating” a claim in order to delay benefits. Georgia law does place some mandatory timelines on how soon insurers have to provide benefits or a reason for denial; however, these deadlines aren’t always met or enforced by the State Board of Workers’ Compensation.
All the while, you may be unable to work and receive bills in the mail from medical providers. Insurance companies know the kind of stress this is putting on you and make no mistake that they will try to use it to their advantage when negotiating a settlement offer. They are hoping you’ll cave and give up on your claim.
Medical liens and paying for medical treatment
If your work injury claim is controverted and you’re forced to seek costly medical treatment and care out-of-pocket, there are some options that we can help you pursue. One such option is through a medical lien.
Some medical providers will agree to provide treatment on a “lien” agreement, meaning you won’t have to pay for treatment or care at the time the service is given. Rather, the cost of treatment will be owed once your claim settles and will come out of your settlement amount.
Generally, doctors and medical facilities that accept medical liens in workers’ compensation cases will require the patient (and their attorney) to sign a “letter of protection.” This legally binding contract provides the medical provider assurance that their costs will be paid from the final settlement.
Although medical liens aren’t the best option for injured workers and attorneys since it reduces the amount the claimant gets to take home at the end of the day, it’s one possible solution if you’re unable to pay for medical treatment out-of-pocket while your workers’ compensation claim is controverted. The experts at WPMH Legal can explore all of your options and help you determine the best one for you.
“Great staff. Very professional and knowledgeable. Staff went out of their way to accommodate us in every way possible. Made the whole process less painful. They made sure we understood everything that was going on and would answer any questions a hundred times over if needed.”
The resources needed to win
Unlike some work injury attorneys who settle all of their cases, we are not afraid to appeal a denied claim if needed. Our firm has the resources needed to thoroughly prepare, try and win complicated cases.
We are dedicated to doing everything legally and ethically possible to obtain the best results for our injured clients. Hard work and dedication have allowed us to recover millions of dollars in verdicts and settlements for our clients in workers’ compensation and personal injury claims.
Injured in the office? Our attorneys can help
If you or a loved one were injured on the job in Georgia and you just found out that your claim is controverted, it’s time you fully understood your rights and responsibilities. Our workers’ comp attorneys can explain what steps to take next and help protect your rights before it’s too late. We can help you find a qualified physician and contest your workers’ comp claim status. If your benefits were unfairly denied, we’ll fight to appeal the decision and help hold any negligent third party accountable for your pain and suffering.
If you have questions, give us a call or contact us online for your free consultation with a knowledgeable and experienced lawyer. From offices in Macon, Albany and Warner Robins, we help injured workers throughout Georgia. Don’t settle for less, get more.