When somebody gets injured or becomes ill during the course of their work duties, they should be entitled to receive compensation. The Georgia workers’ compensation system is designed to ensure that every employee receives benefits in the event an injury occurs, but there are often times when insurance carriers or employers deny benefits that should be paid out to workers. Here, we want to discuss some of the reasons why a claim may be denied as well as what you can do if you have been informed that you will not be receiving workers’ compensation benefits after sustaining an on-the-job injury.
Reasons Why a Claim Could Be Denied
There are a plethora of reasons why an employer or their insurance carrier will deny an insurance claim. Most insurance carriers will do anything they can to limit the amount of money they payout in a settlement. Some of the most common reasons for workers’ compensation claim denials in Georgia include the following:
- Missed deadlines. Work injuries must be reported to the employer within 30 days from when they occur or from when the worker is diagnosed. A workers’ compensation claim must be filed within one year from the date it occurred, even after the initial report is made to the employer. If a work injury claim is not reported on time or if the statute of limitations is missed, the claim will likely be denied.
- Claim filed after you left the job. There are times when employees who are legitimately injured at work delay filing their claims. This sometimes means that workers are fired or laid off before they get to make their initial report. When this occurs, the employer or insurer may assume that the work injury claim has been made out of revenge, leading to a denial.
- Drug or alcohol impairment. In the aftermath of most work injuries, the injured worker will undergo drug or alcohol screening. If medical records show that there were illicit drugs or that the worker was impaired at the time the injury occurred, the insurance carrier will likely deny the claim.
- Discrepancy between accident report and initial medical records. Insurance carriers or employers will often delay a workers’ compensation claim if the employee’s statements about the injury are inconsistent with later reports or the medical records. If an employee tells their employer that the injury happened one way, but then tells their doctor that the accident happened in another way, this could lead to a claim denial.
- The injury was unwitnessed. Insurance carriers and employers do not like to pay for claims of injuries that were unwitnessed. Insurance carriers and employers will likely question most unwitnessed accidents.
What to Do if It’s Denied
If you or a loved one have sustained a workplace injury or illness, you should be entitled to compensation for your losses through the workers’ compensation system. However, if your work injury claim has been delayed or denied, it is time for you to seek assistance from a skilled Newnan workers’ compensation attorney. An attorney with experience handling this type of case will have the resources and legal expertise necessary to prove how your work injury occurred and walk you through this entire process, including any necessary appeals.