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Why was your workers’ comp claim denied?

On Behalf of | Jun 18, 2021 | Workers' Compensation |

Even if you suffered a work injury that should be covered by Georgia workers’ compensation, your claim for benefits might be denied if you didn’t file the right paperwork or didn’t follow the right procedure. Many workers get shut out from receiving benefits because they missed a deadline or didn’t promptly report their injury to their employer.

In general, the workers’ comp insurance company is looking for any possible reason to deny benefits, so it’s important to get help from a workers’ comp lawyer who has the experience and skill to get your claim approved.

IMPORTANT: Just because the insurance company denied part or all of your claim does not necessarily mean that you can’t get benefits. In many cases, injured workers just need help from an attorney who knows the system and how to get the job done. With a workers’ comp lawyer on your side, you can focus on your health and family while your lawyer builds a strong claim and helps you get the benefits you need.

Common reasons for denied claims

Your workers’ comp claim could be denied in whole or in part for any of these reasons:

  • The doctor who treated your injury didn’t know it was work-related. When you go to get treated for your injury, be sure to tell the doctor that your injury is related to your job duties. And tell your doctor exactly where your injury is causing pain and discomfort.
  • The claim did not include sufficient medical evidence of the injury.
  • The employer claims your injury happened outside of work or otherwise wasn’t work-related.
  • The employer claims you had alcohol or drugs in your system at the time of the accident.
  • The employer or insurance company claims you waited too long to report the injury. Usually you have to report your injury to your employer within 30 days of the injury.
  • There are gaps in your medical treatment (usually this happens when an injured worker stops following the doctor’s orders). The insurance company may then claim your injury doesn’t need coverage because supposedly you don’t need treatment anymore, when really you do.
  • You had a prior injury or condition to the same body part. Always be up front about that. However, make clear to your employer or the doctor that you were doing well prior to the new injury and that the current problem has nothing to do with any prior conditions.

Don’t give up after a denied claim

A single rejection does not necessarily mean that you don’t qualify. You might just need to provide more evidence or get a medical evaluation. An experienced workers’ comp attorney can help you gather all the evidence you need and expedite your case.

For more on these matters, please see our Georgia Workers’ Comp Dos and Don’ts.


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