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Why Did They Deny My Workers’ Compensation Claim?

In 2015 alone, there were 39,899 workers’ compensation claims filed in Georgia. Many workers’ compensation claims are denied at first.  Likewise, a lot of people only see a Georgia workers’ compensation lawyer after receiving their denial letter. The pain and suffering caused by a work-related injury is bad enough, but having a claim denied can add insult to the injury. It is easy to treat a denial as the end. The injured person gets on with life and goes back to work, even though he or she is not fit to do so. Or, perhaps the injury is so severe that the person cannot return to his or her job, so a family begins to suffer financially. Many people have tried to unsuccessfully appeal denials. In fact, very few succeed without the assistance of an attorney.  There is hope, however, and it starts with understanding why many claims are denied.

You Missed the Deadline

There is a 30-day deadline for filing your “notice of injury” in order to preserve your right to file a Georgia workers’ compensation claim.  Much like a statute of limitations for filing personal injury cases, this strict deadline acts to limit the time that can lapse between the injury and when the responsible party is put on notice that there may be a claim. A month sounds like plenty of time to provide notice, but many people procrastinate or simply do not understand the process. Therefore, they fail to meet the deadline.

Drugs and Alcohol

Most employers will order a urinalysis following a workplace injury. If you test positive for illegal drugs, alcohol, or in some cases prescription medications, you could be denied. The argument is that your own intoxication or violation of company policies likely caused the injury.  This may or may not be the case. However, it is a frequent reason for denials.

Employer Claims the Accident Was Not Work Related

This common tactic is tricky. Only workplace injuries are covered by workers’ compensation insurance. Therefore, if you are injured driving to work, it is not generally a workplace injury that will be covered. However, if you are required to drive your vehicle for work and are injured while making a delivery, it would probably fall under the definition of a workplace injury.  As you can see, there is a fairly wide gray area where an employer can attempt to avoid responsibility

Employee Fails to Provide Requested Information

Employers are generally very hesitant to pay out on claims, except in the most obvious injuries.  Much like auto accident claims or any other form of insurance claim, the adjuster’s job is to manage liability. In other words, pay as little as possible while avoid a lawsuit. To do this, an adjuster will often try to get as much information as possible regarding pre-existing health conditions, which often includes getting your records. You are not legally required to provide your entire medical history nor sign blanket authorizations for unrelated issues or mental health treatment records. Nevertheless, the adjuster may request it. If you refuse to provide the information or authorizations, it is often used as a reason for denying your claim.

Further, you may have been asked to give a formal statement. This too is a problem, because you are not required to do so. Many workers have refused to do this in fear of saying something that could be used to deny their claim unjustly, only to have their claim denied for refusing to give the statement. It puts the worker in a true catch-22.

What to Do If Denied Benefits

These are just a few common examples. There are plenty of other reasons a claim could be denied. If you receive a denial letter or are being asked to provide records or information, you should contact an attorney right away. You can simply explain that you are too busy to talk or make up some other excuse and schedule a time to return their call. This way you are not yet refusing, but simply stalling. Immediately contact a Georgia workers’ compensation attorney who can explain your rights and options and help you decide what to do next.

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