Stephen Hasner | Workers' Compensation | March 23, 2023
The Georgia workers’ compensation system is a no-fault accident insurance program for injured workers. Most employers are required to pay for workers’ comp insurance for their employees. An injured worker can receive benefits to help them return to work after a work-related injury.
Your workers’ comp claim begins by reporting your accident to your employer. Reporting the injury to the employer within 30 days is essential, or you could lose your workers’ comp benefits.
Filing a workers’ comp claim and receiving workers’ compensation benefits should be straightforward. The employee does not need to prove fault or negligence for the accident. Instead, the worker only needs to show that they were injured during the ordinary course of their employment.
Unfortunately, the workers’ compensation process is not always smooth. Your employer or the workers’ comp insurance company might deny your claim. If so, talk with an Atlanta workers’ compensation lawyer about the workers’ compensation appeals process in Atlanta.
Why Did the Insurance Company Deny My Georgia Workers’ Compensation Claim?
The workers’ compensation insurance provider or your employer has the final say on whether your workers’ comp claim is approved. The insurance company might deny your workers’ comp claim for one or more reasons. However, it does not mean you are not entitled to workers’ comp benefits.
Common reasons for denying a workers’ comp claim include, but are not limited to:
- Failing to report your workplace injury to your employer within 30 days. However, there could be exceptions in some cases if your employer already knew about the injury or you were unaware of an occupational illness.
- You intentionally caused your injury or were intoxicated when you were injured.
- The injury resulted from horseplay or other misconduct not covered by workers’ comp insurance.
- The injury occurred when you were not “on the clock” or performing work-related duties.
- The injury occurred because of something that is not work-related, such as injuries caused by a pre-existing medical condition.
- Another party intentionally caused your injury.
Some workers’ comp appeals do not relate to a denied claim. You might need to file a workers’ compensation appeal because your average weekly wage was miscalculated. Another reason to file an appeal would be to request a change in physicians or challenge a return to work finding by a doctor.
The workers’ compensation appeals process in Atlanta can be confusing. There are many deadlines and requirements to file an appeal. Hiring a workers’ comp attorney in Atlanta can help make the process easier and increase your chance of winning the appeal.
How Do You Appeal a Workers’ Compensation Denial in Atlanta, GA?
You must file a notice of claim on a state-approved form to begin the appeals process. The appeal must be filed with the Georgia State Board of Workers’ Compensation within one year from your injury date. You must also send a copy to your employer and your employer’s workers’ comp insurance provider.
It is best to appeal a denial of a workers’ compensation claim as soon as possible. The appeals process could take some time. Furthermore, filing quickly helps preserve the evidence you need to prove you are entitled to workers’ comp benefits.
An Administrative Law Judge (ALJ) will hear your appeal. The State Board schedules a hearing and notifies all parties. Most hearings occur within 60 days after you file your appeal.
A workers’ comp ALJ hearing is like a trial, except the Administrative Law Judge is the jury and the judge. You can present evidence supporting your claim for workers’ comp benefits. You can call witnesses to testify on your behalf, including medical specialists and other expert witnesses.
The workers’ compensation company can also present evidence at the trial, including calling witnesses. In addition, both sides can cross-examine witnesses presented by the other side.
The ALJ decides the case based on the evidence, facts, and applicable law. Typically, the ALJ issues a written opinion within 30 days after the hearing.
Appealing the Decision by a Workers’ Comp Administrative Law Judge
If you disagree with the decision of the ALJ, you can appeal the decision to the Board’s Appellate Division. You have just 20 days to file an appeal of an ALJ decision. The Appellate Division has a Chairperson and two Board members who decide the cases.
It is crucial that you introduce all evidence you want the Board to consider during the appeal to the ALJ. You cannot present new evidence during an appeal to the Appellate Division. The decision is made on the evidence in the file and briefs submitted by the attorneys.
You can request the opportunity to present an oral argument. If approved, the oral arguments are scheduled within 60 days of filing. However, oral arguments are limited to five minutes for each party.
The Appellate Division defers to the judgment by the ALJ unless there is a clear error or mistake that justifies the ALJ’s ruling to be reversed.
Appealing a Georgia Workers’ Comp Claim to a Court
If the Appellate Divisions upholds the ALJ decision, you can file an appeal of the workers’ compensation denial to the Georgia courts. The Superior Court hears these cases.
Only issues of law are considered on appeal. Therefore, the court assumes the factual findings in the case are correct.
An appeal from the Superior Court must be filed within 20 days to the Georgia Court of Appeals. Again, the Court of Appeals limits its review of the case to matters of law and only reviews the documents filed in the case.
Because the appeals process for workers’ comp denials can be complex with short deadlines, you need to contact an Atlanta workers’ comp attorney immediately if your workers’ comp claim is denied.
Contact the Atlanta Workers’ Compensation Lawyers at Hasner Law, P.C. For Help
We serve in Fulton County, Chatham County, and its surrounding areas: