Was your workers’ comp claim denied?
A denial is NOT the end of the road.
Let our Macon attorneys fight to secure the benefits you’re owed.
577 Mulberry St, Suite 600
Macon, GA 31201-8242
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Workers’ compensation claims can be denied for a variety of reasons. A denial doesn’t mean a work-related accident did not happen and you were not injured, and it certainly isn’t the end of the road when it comes to seeking compensation for your on-the-job accident or illness. Most denied claim cases that we handle simply involve a failure to present all the facts in an effective manner.
Experience and knowledge are paramount when selecting the right workers’ compensation lawyer to help you fight a denied claim. At the Macon law firm of Westmoreland, Patterson, Moseley & Hinson, our attorneys leverage 200 years of combined experience and insight to deliver the best possible results for our clients—whether you need help during the initial application process or appealing a denial.
Why was your claim denied – And what can be changed?
Every workers’ compensation case is different and honest attorneys will wait to consider the unique factors that might be at play in your case before promising a positive outcome. That said, we’ve found that many of the injured workers we represent run into similar roadblocks in their workers’ comp claim.
- Incorrect filing information. A study by the National Institutes of Health revealed the vast majority of workers’ comp claims (78.8 percent) were denied because the medical provider and the patient had incorrect workers’ compensation carrier information.
- The injury wasn’t work-related. If injuries are not believed to be related to the work accident or the injury occurred while not on the premises of the employer, the insurance company is more likely to deny your claim.
- Delayed notification and missed deadlines. If you failed to notify your employer about your injury or illness as soon as possible, they or their insurer may try to argue that the incident wasn’t work-related and happened while you were “off the clock.” Generally, you must notify your employer of an injury within 30 days. The longer you wait, the more likely your claim will be denied.
- The injury involved drugs, alcohol or misconduct. Allegations of “horseplay” or willful misconduct involving alcohol or drugs often result in insurers and employers denying workers’ compensation claims. Your employer generally has the right to test you for drugs and/or alcohol following a workplace accident, and you may not be entitled to benefits if a test shows that you were under the influence.
- Pre-existing condition. If your medical records show that you suffered a related injury or illness before starting your job or that was the result of an incident outside the workplace, insurers are more apt to deny a claim by claiming that your pre-existing condition is to blame rather than a workplace environment or incident. It’s important to understand than you can still receive workers’ comp benefits for a pre-existing condition so long as you can prove that your job aggravated or worsened your condition. Nevertheless, this is a common reason why claims are initially rejected.
A denial is NOT the final decision. Options exist in appealing the denial or pursuing a civil claim for your injuries. We treat each workers’ compensation claim individually, understanding that unique issues exist. Regardless of how we pursue compensation following a denial, we will employ all of our resources to fight for the best possible outcome.
Workers’ comp denial statistics
Insurers and companies across various industries regularly try to reduce their costs and boost profit by denying workers’ compensation claims. In fact, these facts and statistics from 2017 reveal just how common the practice of rejecting claims is:
- Nearly 7 percent of all workers’ comp claims were denied.
- In a survey, nearly half (47 percent) of respondents who ultimately received a settlement or award initially had their workers’ comp claims denied.
- The denial rate for workers’ comp claims for all industries jumped by roughly 20 percent between 2013 to 2017.
- Nearly 70 percent of claims that were initially rejected were eventually paid within the year.
- The amount of compensation awarded for a converted claim is on average 55 percent higher than a claim that is approved initially. The average cost of accepted claims was $10,153. For those initially rejected but later paid (without the need for litigation), the cost rose to $15,694.
- The average cost of rejected claims that wound up in court was nearly $37,000, more than double the already higher-than-average cost paid after an initial rejection.
- 70.6 percent of denied claims are litigated, meaning that attorneys are involved.
- Denials based on drug or alcohol use were later paid out at a rate of 76.9 percent.
- Denials based on “no injury by statutory definition” ended up being paid out 71.6 percent of the time.
- Denials based on “willful intent to injure oneself” had an 88.9 percent payment rate.
- Denials based on claims that a recreational or social activity was the cause of the injury were eventually paid out more than 71 percent of the time.
- Denials based on a claim that a preexisting condition was to blame were ultimately paid at a rate of 68.9 percent.
How long do you have to contest a workers’ comp denial?
If your claim was denied, it’s important to realize that there is a ticking clock if you’re planning on disputing the denial. This deadline, known as the “statute of limitations,” varies from state to state and strictly enforced.
After filing your claim, you may need to engage in mediation to try to negotiate a resolution without going to court. If mediation is unsuccessful, your claim will move to a workers’ compensation hearing. During the hearing, your attorney will make legal arguments and present evidence to an administrative law judge (ALJ). The judge must make a decision within 30 days.
If the ALJ doesn’t rule in your favor, you may be able to appeal the decision by escalating your claim to the appellate division of the SBWC. To do so, you must file an application for review within 20 days after the ALJ’s ruling.
If the SBWC appellate court rules against you, you can appeal your claim one step further by filing a motion with the Georgia Court of Appeals. You or your lawyer must do so within 20 days after the SBWC’s decision, in the county where you were injured.
Fighting a workers’ compensation denial can be a long and complicated process, with many important deadlines. Having an experienced Georgia workers’ compensation attorney by your side is the best way to ensure that you’re pursuing all available options and securing the maximum benefits available to 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.
Consult a respected Georgia workers’ comp law firm about fighting a denial
Our attorneys attend to every detail when investigating accidents, interviewing witnesses and reviewing medical reports to build fact-based claims. We frequently represent clients who have had a workers’ comp claim denied for whatever reason, and we have successfully challenged unfair denials.
If your workers’ compensation claim or benefits were denied, contact us today for your free consultation. From our offices in Macon, Albany and Warner Robins, we help injured workers throughout Georgia. Don’t settle for less, get more.