Unforeseen accidents on the job can catch you off-guard, leading to painful injuries and time off work. You may try to get help through the Workers’ Compensation system but run into difficulties accessing your benefits.
Often, people have questions about Workers’ Compensation.
What happens if your claim is denied? What if your employer doesn’t believe you were injured on the job or expresses doubt about how the injury happened? How can you pay your medical bills and regular expenses when you’re unable to work?
How a Kennesaw Workers’ Compensation Attorney Can Help
Workers’ compensation is available to most workers who are classified as employees, but few people know all their rights under the Workers’ Compensation system. Your employer’s insurance company adjuster, on the other hand, knows all the ins and outs of the system and how to use them against you.
The adjuster doesn’t want to pay any more claims than they have to, and they will go over your claim with a fine-toothed comb, looking for any excuse to reject it.
They might get help from your boss, too. Your supervisor has probably been encouraged to keep Worker’s Comp claims to a minimum in order to avoid a hike in insurance rates.
Ideally, they should do this by ensuring the workplace is as safe as possible so fewer injuries happen. But in the real world, sometimes bosses “lose” Worker’s Compensation paperwork or disagree with the employee’s explanation of how the injury happened.
Your workers’ compensation attorney will review your claim form and assist you with any questions or concerns you have. We’ll point out any discrepancies or other issues that might cause problems and advise you of any paperwork you may need. We can also help if you’ve already filed a claim and received a denial.
Why Was Your Workers’ Compensation Claim Denied?
People often ask us this question in frustration, and we understand how upsetting a denial can be. You worked hard and expected Workers’ Compensation to help if you were ever injured on the job, but now you’ve been turned down for reasons that may seem vague or unfair.
We’ll review your claim and try to determine what went wrong, then we’ll explain your options for fighting the denial.
Here are some common reasons for claim denials that you may encounter:
There Was a Problem With the Paperwork
The forms you have to fill out can be confusing, and your HR representative may not be especially helpful.
Sometimes, people make mistakes because they’re not sure how to answer a question on the form. In other cases, they may submit incomplete information because their HR representative gave them the runaround about providing insurance information, so they submitted without it.
If this happens to you, please call a lawyer right away. Other workers find that they’ve missed the deadline to file a claim or have run into other challenges with the paperwork.
Your Employer Disagrees With Your Claim
Once you file a Worker’s Compensation claim, your employer is expected to respond. If they agree with the details of your claim, that removes one potential hurdle (but you may still have difficulty with the insurance company).
However, in many cases, the employer doesn’t agree with your claim. Here are some of the everyday situations we see:
- Your employer doesn’t think your injury is real. This can be infuriating, but resist the urge to get into an argument with your boss or HR representative. A better alternative is to talk with a lawyer who can help you gather evidence like medical records to prove your case.
- Your employer accepts that your injury is real but questions whether it actually happened at work. This is more likely if you had an accident when no one else was around to witness it or if you have a repetitive motion injury. Your attorney will help you find other evidence, such as witnesses who saw you at work right after your accident happened, video evidence, or other electronic documentation. With repetitive motion injuries, we may speak with medical experts who can testify about how this type of injury happens, the activities that usually cause it, and whether your work activities are likely to be the cause.
- Your employer doesn’t think your injury happened at work, part II. There is another variation where your employer agrees that you were injured and may even admit you were hurt in your workplace – but they say your injury doesn’t count because you were on a lunch break or otherwise clocked out. In these situations, we can usually find electronic records of when you were clocked in and out, but we’ll ask you questions to provide context. If you were on your lunch break, for example, but you were performing a work-related task like buying supplies for the office when you slipped and fell, then you still suffered a work-related injury. Accidents that happen on breaks can sometimes count as compensable injuries if you were hurt due to some hazard in the workplace, such as a loose floor tile that caused you to trip and fall in the breakroom.
- Your employer says they weren’t notified of your injury in a reasonable amount of time. The best way to avoid this situation is to make sure you notify your employer of the injury in a way you can prove later, immediately after your accident, or as soon as possible (within 30 days at the latest). Frequently, we meet people who tell us that they did inform their supervisor or HR rep the day of the accident, but that person swears they have no recollection of the conversation. For this reason, we recommend one of the following solutions: Either send your supervisor an email from your personal account or text them from your personal phone. Using a personal address or device is essential because your employer can’t cut off your access, so you will always be able to pull up the sent email or text.
- Your employer believes that your injury was the result of intoxication, horseplay, or it was intentional. Worker’s Compensation is, for the most part, a no-fault system. You don’t have to prove your employer was negligent or that you weren’t at fault to receive benefits. However, there are a few exceptions. If you were at fault because you were under the influence at work, your claim could be denied – that’s why employers often insist on an immediate drug and alcohol test after any accident. You can also be denied if your accident happened while you were engaging in horseplay or if you intentionally injured yourself. Horseplay and intentional actions are usually harder to prove than intoxication, but that doesn’t mean your employer won’t try. We will work to refute your employer’s claims and show that the injury was indeed an accident.
- You didn’t go to an approved medical provider. Like many states, Georgia allows employers to choose the medical providers who treat Worker’s Compensation injuries. If you are injured and need to see a doctor, ask your supervisor or HR rep for a list of approved providers. This can be a Panel of Physicians with at least six doctors on the list or a managed care organization that can assist you with scheduling an appointment. If your employer is not forthcoming with this information, call a lawyer immediately. In an emergency situation – such as injuries that threaten life or limb – you can go to the nearest emergency room, but you should see an approved provider for any follow-up care.
- You didn’t seek medical treatment, or you didn’t do so quickly enough. Many people initially feel fine after a work accident, or they may shrug off their injuries as minor. As a result, they might not go to a doctor immediately but may see one later if their pain or symptoms don’t go away. If you wait for several days or more before seeing a provider, your employer or their insurance adjuster may believe that your injuries happened elsewhere or weren’t that bad. We recommend seeing a doctor within a few days of your accident, even if you think your injuries are minor. Then, if you suffer continued symptoms, you will have an initial record of the injury and your diagnosis. If your employer wastes time getting you the list of providers or you can’t schedule an appointment with any of them in a reasonable time frame, please document your attempts to either get the list or make an earlier appointment. That will help us show that you made a reasonable effort to see a doctor right away.
- The employer or the insurance company adjuster doesn’t believe your treatment was necessary. More often, the insurance adjuster is the one who objects to a specific treatment. They may suggest that a less expensive treatment is a better option, etc. We will use your medical records and possibly testimony from your doctor or other medical experts to explain why the treatment was needed in your case.
Where Can You Get Help From a Kennesaw Workers’ Compensation Law Firm?
If you need help filing a worker’s comp claim, requesting a hearing, or fighting a denial, please contact the CEO Lawyer Personal Injury Law Firm for a free consultation. We’ll walk you through the claims process, answer questions, and explain your options.
There is no obligation, and if we take your case, you won’t owe us anything until we win or settle it.
The CEO Lawyer Personal Injury Law Firm was founded by attorney Ali Awad, who has since expanded it into one of the fastest-growing personal injury law firms in the country. With his skilled legal team, Mr. Awad has recovered millions of dollars in compensation for injured people and their families.
He also creates entertaining yet informative posts about legal topics for more than a million followers on social media. Call (470) 323-8779 to work with his expert team today.
