How to Appeal a Denied Workers’ Comp Claim

Workers’ Compensation claims can be a complicated system, but what happens if you claim was denied?

According to the Georgia State Board of Workers’ Compensation, if your claim is rejected, you have just 20 days to appeal the decision. To appeal, you have to file a request for an oral argument hearing with an administrative law judge by writing to the address listed on the state board website. Upon receiving your request, the board will set a hearing date within 60 days of your filing the appeal. When the date is assigned, the board will notify all parties of the time, date, and location of the hearing, as well as the name of the judge who will preside.

It’s important to hire an experienced workers’ compensation lawyer as soon as possible so that your attorney’s team will have time to do additional research and obtain any additional documentation that would help solidify your case before your hearing. You don’t ever want to appear before a judge without an attorney who can make full use of their knowledge and training to get the best result for your situation. If your appeal is successful, your awarded benefits should include compensation for legal fees.

There are two types of claim denials.

1. The insurance company denies you were injured on the job or denies you were injured to the degree which you claimed.
2. The insurance company denies your injuries should receive compensation because of the body part that was injured, the doctor who treated you, or another aspect of your claim.

There is no jury in workers’ compensation cases, so the administrative law judge will be solely responsible for ruling about your claim. There also aren’t any settlements in workers’ comp cases. If the insurance company denied your claim in the first way listed above, the judge will determine (1) if you were hurt on the job, and (2) if you should receive benefits from the insurance company. If the insurance company issued the second type of denial, the judge will only determine if you should receive benefits. Benefits include medical treatment expenses, incidental expenses, disability benefits, and compensation for legal fees. The judge can’t award sums of money or settlements for your injuries. To obtain a settlement, against your employer for example, you’ll need to file a personal injury lawsuit.

Georgia state law is unique in that it lets insurance companies pay for a worker’s medical benefits without forcing them to also pay your indemnity (compensation for wages lost due to your injury) and other benefits. If this occurs, your appeal has been denied. The insurance company is trying to pay just part of your claim so they can get away with not taking legal responsibility for the full extent of your injuries. Your medical bills may be the most pressing stressor in your life at the moment, so many people are tempted to accept that level of compensation and not appeal. However, if you were injured on the job, you are entitled to full legal compensation, including loss of wages while you were injured or seeking medical treatment, loss of wages because you had to be put on light-duty work, temporary disability benefits, and your legal fees.

If you have already appealed once and had your hearing before the administrative law judge and wish to appeal the decision further, you can appeal to the State Board of Workers’ Compensation, then to the superior court, the Court of Appeals, and possibly even to the Georgia Supreme Court. Because workers’ compensation is a matter of state law, you can’t appeal on a federal level or to the United States Supreme Court. It’s best to speak to an attorney about your full appeals process.

Time is of the essence. As a registered nurse, I’m uniquely qualified to understand your injuries and their effect on your life. Contact me today to set up a free consultation, and let’s get the ball rolling so I can help you obtain all the compensation and benefits you deserve.