Georgia Workers’ Compensation Guide to Controverted Claims

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.

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).

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.

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.

Don’t let insurers intimidate you or wrongly delay or deny benefits. We will make sure you are treated fairly and justly.

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 Westmoreland Law can explore all of your options and help you determine the best one for you.