6 Common Reasons Workers’ Compensation Claims are Denied

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workers' compensation claim denied in Atlanta

When on-the-job injuries occur, workers’ compensation benefits provide a safety net to help make up for medical expenses and lost wages you suffer. Unfortunately, getting the benefits you are entitled to can be a challenge, and in too many cases, workers’ claims end up being denied.

At Hasner Law PC, we understand how important these benefits are in providing for yourself and your loved ones when work-related accidents occur. Contact our Georgia workers’ compensation lawyers today for professional help in protecting your rights so that you can get the benefits you deserve. Unfortunately, in over 60 years of representing injured workers, one of the most commonly asked questions we hear from new clients has been: “Why was my workers’ comp claim denied?”

Why Workers’ Compensation Denied Your Claim

Workers’ compensation is a form of insurance that is regulated in our state by the State Board of Workers’ Compensation (SBWC). Workers who are injured on the job are entitled to medical, rehabilitative, and income benefits, provided they meet certain requirements. Among the most common reasons that workers’ compensation claims end up being denied are the following:

1. You Didn’t Report Your Injury Immediately

As outlined in the SBWC Employee Handbook, injured workers are required to formally report their injuries to their employers within 30 days after their injury.

2. Your Injury Was Not Witnessed

When an accident occurs, it is important to note any witnesses at the scene. Failing to identify coworkers or others as witnesses could cast doubt on exactly how and when the injury occurred.

3. You Failed To Seek Appropriate Medical Care

The SBWC requires employers to post a list of approved medical providers for injured workers. Your claim may be denied if you fail to see a doctor or go to an unauthorized provider.

4. There is a Discrepancy Between Your Accident Report and Initial Medical Records

Seeing a doctor promptly, reporting all symptoms you are experiencing, and undergoing any recommended tests plays a vital role in proving work-related injuries and getting your claim approved.

5. Your Injury Did Not Occur On The Job

Pre-existing injuries not aggravated by a work-related accident and those that occur on the way to or from work are not covered by workers’ compensation.

6. Blood Work Confirmed The Use Of Alcohol or Drugs At The Time Of The Injury

In the immediate aftermath of your accident, a blood test for alcohol or drug use may be performed. If you are found to be under the influence of any type of mind-altering substance, your claim will be denied.

Appealing A Denied Claim

In the event your workers’ compensation benefits are denied, you will be notified of the reasons for the decision. You have the right to appeal the SBWC’s decision, which you may do by requesting a hearing within the appropriate time frame.  At this hearing, evidence from both sides will be presented before an administrative law judge, who will then make a decision in your case. You have the right to hire a lawyer at any point during this process, and it is recommended that you do so in order to ensure your claim is represented properly.