In 2013, there were over three million non-fatal cases of workplace injuries and illness in the U.S., according to the Bureau of Labor Statistics. Many of these conditions can disable a worker for a substantial amount of time. In fact, for every eight workers, one of them will be disabled for five years or more at some point during their working careers, reports the Council for Disability Awareness citing other data.
When employees suffer injuries on the job, they are entitled to medical and income benefits, as per Georgia workers’ compensation laws. Workers’ compensation benefits can become extremely critical for workers and their families. But what if the employee is denied workers’ compensation in Atlanta by the insurer or Administrative Law Judge (ALJ) presiding over the claim?
5 Reasons an Insurer Could Deny a Workers’ Compensation Claim
Unfortunately, claims are denied by insurers all the time, often unjustly. In some cases, it might be because human resources departments and the employers’ insurance claims adjusters were poorly trained or carrying too heavy a workload to assess the claims properly. In other cases, the insurer may use whatever excuses it can in order to reject the claim to reduce payouts. Insurers are, after all, for-profit businesses, and their bottom-lines tend to supersede workers’ needs.
There are several legitimate reasons an insurer might deny a workers’ compensation claim. Below we briefly discuss five of the most common reasons claims get denied. However, no matter the insurer’s reason for denying your claim, you should consider hiring a workers’ compensation lawyer to request a hearing and defend your rights to income benefits.
1. Statutes of Limitations
There is a time limit, or statute of limitations, on when you can file a workers’ comp claim. The State of Georgia provides different statutes of limitation depending on the particular circumstances. The time limits range from one year to four. You should ask your attorney which applies to your situation.
2. Type of Employment
There are certain types of workers who are not eligible for workers’ compensation benefits. These workers are:
- Farm laborers.
- Federal government employees.
- Independent contractors.
If a workers’ compensation insurer denies your claim on the basis of your employment status or employment type, there might still be a way to prove your eligibility. Learn more here.
If your employer uses intoxication and drug test results as the basis for denying your workers’ compensation claim, you can and should request a hearing. Click to read more on denials based on intoxication and drug tests.
Insurers deny some claims because they argue that the worker’s injury or illness is not work-related. In order to qualify for workers’ compensation benefits, it has to be proven that your injury was caused by a work accident or work-related duties. Read our full page on causation to learn more.
5. Undisclosed Pre-Existing Injury
Employers may try to deny your claim by accusing you of hiding a pre-existing injury or condition that contributed to or exacerbated your current injury. If the denial is based on this assumption, the employer and insurer will have to prove it. Learn how by reading our full page on pre-existing conditions.
When an ALJ Denies a Workers’ Compensation Claim
Legally speaking, an “appeal” is the process for seeking a reversal of a hearing award. When an ALJ denies a workers’ compensation claim, an injured worker can appeal the judge’s decision.
Denied workers’ compensation claim? We can help
The attorneys at Bader Scott Injury Lawyers can help you develop a defense if an insurer or ALJ wrongly denies your claim. For a lawyer in Atlanta, contact us today at 678-562-5595 for a free consultation.