It is no secret that the insurance companies that administer workers’ compensation policies will find any possible excuse to deny a claim. They may argue that an injury was unrelated to an individual’s job or that the resulting injury is not sufficiently serious to merit payment. These denials can be devastating to a worker who is unable to return to their job because of an occupational injury or disease.
Thankfully, every worker has the right to appeal a workers’ compensation denial. Typically, the first step involves having a hearing before an officer of the State Board of Workers’ Compensation. However, a worker can demand a full judicial appeal if that hearing fails to bring satisfactory benefits. A Gainesville workers’ compensation appeals lawyer is ready to help injured and ill employees pursue the benefits that they deserve. Contact Smith Hulsey today to discuss your unique situation with a seasoned attorney.
To understand why an insurance company may deny a claim, it is essential to know the basic elements of that claim. To receive appropriate workers’ compensation benefits, an employee must be able to prove that their injury or disease was the consequence of them performing their job. They must also show that the injury or illness is enough to keep them out of work.
Insurance companies may dispute either portion of the claim. Normally, the dispute concerns whether the injury was related to an employee performing their job. The Official Code of Georgia Annotated § 34-9-1(4) defines a compensable injury as an injury that arises out of and in the course of employment. This may also include a disease or infection resulting from their line of work or an injury sustained while on the job.
Disagreements may also arise concerning the extent of a worker’s injury. The treating doctors should provide their opinion on how the injury limits or destroys a person’s ability to do their job. If an insurance company refuses to accept this claim, it may result in a denial. A Gainesville workers’ compensation appeals attorney could help explore the reasons for a denial and identify any flaws in the insurance company’s logic.
Ideally, a worker will receive proper benefits without asking the State to intervene. However, the State Board of Workers’ Compensation retains the authority to adjudicate disputes between workers and insurance companies. Any employee may petition the Board to hold a hearing to resolve disputes. The first step is to request a formal session with a hearing officer working for the Board.
If this hearing fails to result in a beneficial claim, all workers have the right to request a rehearing before an Administrative Law Judge. However, this is only possible if a worker can show that the original hearing officer made a mistake of law that damaged the worker’s case. Examples include failing to apply the rules of the hearing correctly or excluding relevant evidence for improper reasons. A Gainesville attorney is ready to explain further how workers’ compensation appeals work and take the lead in representing the interests of employees during these sessions.
Every worker has the right to a hearing or an appeal after receiving a worker’s compensation denial. Reasons for a denial may include a lack of workplace connection or insufficient medical evidence.
A Gainesville workers’ compensation appeals lawyer could identify the reason for a denial, obtain more information about the incident that led to your diagnosis, and file appeals on your behalf that seek a fair result through negotiation or a full hearing with the State. Contact Smith Hulsey Law today to schedule your confidential consultation.
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