Denials of worker’s compensation claims are not uncommon. Sadly, many employers and insurance companies will look for any reason or procedural error to deny claims and avoid paying injured workers. However, if you were denied benefits that you believe you are entitled to, you have the right to appeal the decision.
After a claim denial, speak to a skilled attorney at Smith Hulsey about appealing worker’s compensation decisions in Winder. Our legal team could advise you on an appropriate strategy for getting the decision overturned at the appellate division. In most cases, denials are worth appealing with legal assistance.
An employer, insurance company, or defense attorney may use various arguments for denying a worker’s compensation claim. The most common reasons include activities outside the scope of employment, drug or alcohol usage, and late claims.
When an employee is not acting in the course and scope of their employment, they are not eligible for worker’s comp benefits for any injuries that occur. This could include horseplay while on the job, as well as any activities that took place off the clock. An employer or insurance company could also argue that the employee misused equipment, disregarded safety procedures, or intentionally injured themselves.
After a worker’s compensation inquiry, many employers will require a drug test. If an employee was under the influence of drugs or alcohol at the time of the accident, the employer could use this evidence to try to deny their claim. They could argue that the intoxication is what caused the work injury, requiring a skilled lawyer to contest this allegation. A positive drug test does not always prevent a person from receiving worker’s comp benefits, but it can make it more difficult.
Another common reason for denied claims is if the injured employee does not take prompt action following their accident. An injured worker should immediately report their injury to their employer and contact legal counsel for help filing the correct notices. This is crucial in preventing the statute of limitations from running out.
After a denied claim for worker’s compensation, the first thing to do is to immediately speak to an attorney in the area. There are specific forms that need to be filed within a certain amount of time to have the decision overturned. A local attorney could work quickly to start the process and move the claim forward after a denial.
First, our lawyers will typically reach out to the insurance company to try and convince them to restart benefits or accept the claim. If this does not work, we will file a notice for a request for a hearing. This leads to a hearing date in front of an administrative law judge. From there, a dedicated attorney at our firm could try to try to get the judge to order the employer to pay worker’s comp benefits.
Once a claim has been denied, there is a timeline for moving forward with the appeals process. First, an injured worker’s attorney will file the notice of appeal with the appellate division of the State Board of Workers’ Compensation. Then, the lawyer will file a brief, which is a written document that supports the motion for an appeal. Finally, all parties involved will present oral arguments in front of a three-judge panel. At each stage of this appeals process, it is crucial to have dedicated support from an experienced lawyer to advocate for the worker’s compensation claim.
Appealing worker’s compensation decisions in Winder is rarely an easy process, especially without firm legal guidance. An injured worker must have significant evidence that their accident occurred during the scope of their employment. Additionally, there are many procedural nuances that they must navigate correctly to achieve a successful outcome.
If you have had your claim denied, work with the attorneys at Smith Hulsey on appealing the decision. Our legal team could advise you on the process and help move your case forward to get you the compensation you need. Give us a call today to discuss.
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