Workers Compensation Claim Denied

The last thing you expect after being injured on the job is to have your workers compensation claim denied. However, this happens all too often. You have the right to appeal a decision but if you try to appeal without legal help, you may find the outcome is less than satisfactory.

Employers are required by law to notify their workers compensation insurance company about any on-the-job accidents within 10 days of them being reported by the employee. Insurance companies may try a number of tactics to avoid paying the full amount of your claim including:

• Injuries from other than job – one of the most popular tactics an insurer will use is arguing that your injuries were not a result of a workplace accident but occurred because of activities you participated in outside the job. To prove this claim, the insurer will often ask you to sign a medical release so they can access your medical records. It is never a good idea to give an insurer unfettered access to medical records that are not associated with your workplace injury. Speak to your worker’s compensation attorney immediately if they ask for this type of a broad release.

• Make an offer you cannot refuse – sometimes insurance companies will make an almost immediate offer to settle your workers compensation claim. This is almost always a tactic that is used that allows them to settle a claim for less than it may cost them over time. For example, if your injury requires long-term medical care, you are entitled to receive not only the cost of medical care but transportation allowance to and from any medical appointments. For an insurer, offering a lump sum up front can be a far more cost-effective option.  If you do not already have worker’s compensation attorney, it is highly recommended you contact one before agreeing to any settlement offer.

• Withhold benefits until you settle – another common tactic insurers may use is to stall payment of benefits until you are facing crippling financial problems and then offer you a settlement. This is because most insurers know that workers can only hold out so long without the income from their worker’s compensation claim. This method often works because employees who are out of work need the money sooner rather than later. Unfortunately, this also means you are likely to waive compensation for future medical care.

After your workers compensation claim has been denied, you are entitled to appeal that claim.  If your workers compensation claim is denied or insurance companies are using unusual tactics to avoid paying your claim you need to contact an attorney immediately to help protect your rights under Georgia’s workers compensation laws.