Appealing a Workers’ Compensation Denial in Georgia

Nov 30, 2016

Appealing a Workers’ Compensation Denial in Georgia

Contracting a job-related illness or sustaining an injury can take a serious physical, emotional, and financial toll on injured employees and their families. Fortunately, injured parties can receive proper medical care and help with bills through Georgia’s workers’ compensation program. Navigating the state’s procedures can be difficult, especially if an initial claim is denied, so if you or a loved one were injured while at work and have questions or concerns about appealing a denial of benefits, it is crucial to contact an experienced workers’ compensation attorney who can assess your claim and help explain your options.

Reasons for Denial

Workers’ compensation claims can be denied for a number of reasons, but the most common include the following:

  • The claimant failed to file a claim within 30 days of the injury;
  • The claimant did not provide enough information about the accident;
  • The claimant or his or her employer did not submit the appropriate paperwork;
  • The claimant failed to provide evidence establishing that the injury occurred during the course of his or her employment;
  • The injured party’s employer disputed the claim, argued that the claimant was not a covered employee, or argued that the claimed injury was a preexisting condition; or
  • The State Board of Workers’ Compensation decides that an injury is not severe enough to qualify under the workers’ compensation laws.

Initiating the Appeals Process

All denials are sent through the mail, so it is important for all claimants to retain a copy for their own records. To begin the appeals process, a claimant must request a hearing with the State Board of Workers’ Compensation (SBWC) by filing a WC-14 form. Once submitted, a copy of this form is also sent to the claimant’s employer as well as his or her workers’ compensation insurer. At the time the form is submitted, the claimant can request either a hearing or a mediation.

Eventually, a claimant will be assigned a hearing date (usually within two months of the submission of the notice of appeal) and an administrative law judge who will hear the case. However, when a party requested mediation or when the SBWC feels that a claim could be resolved through negotiation, the parties will be required to go through the process of mediation before attending a formal hearing. Mediation offers the parties the opportunity to meet and discuss a possible settlement in the presence of a neutral third party. Reaching a settlement that satisfies both employees and insurers outside of a courtroom can save injured parties from the more time-consuming and stressful formal appeals process.

Formal Hearings

If a settlement between the parties cannot be reached, a claimant can then go through the more formal process of a hearing, where he or she will need to provide evidence proving that:

  • His or her injury was incurred on the job during the performance of job-related duties that were within the scope of his or her employment; and
  • He or she properly and timely filed a workers’ compensation claim with the appropriate authorities.

This may require finding witnesses who can corroborate the claimant’s story by testifying under oath in a formal court setting. Both claimants and their employers are also permitted to submit additional documentation, including medical records, expert testimony, and written briefs to the judge. Once the evidence has been presented, a judge will decide whether workers’ compensation benefits are appropriate or whether a denial was legally justified and issue a written judgement reflecting the decision. If a judge denies the appeal, the claimant can take his or her claim to the SBWC’s Appellate Division. However, in these cases, claimants only have 20 days to file the appeal or the claim will be denied.

Filing a Claim With the Appellate Division 

The SBWC’s Appellate Division, which is made up of a panel of three judges, usually decides cases based on written arguments submitted by both parties, although claimants do have the right to request an in-person hearing, which will be held within 60 days of the request. At the hearing, both parties are permitted to make a five minute oral argument to support their case, although no new evidence can be presented. After reviewing the evidence, the Appellate Division also issues a written decision through the mail. If the Appellate Division affirms the previous judge’s denial of a claim, the injured party has the option of filing an additional appeal with the Georgia Superior Court, although he or she must do so within 20 days of receiving the Appellate Division’s judgment.

Filing an Appeal Through the State Court System

Like the Appellate Division, Georgia Superior Courts do not usually hear new evidence, but instead review the evidence, transcripts, depositions, oral arguments, and written briefs that were submitted by the parties earlier in the appeals process. State courts tend to defer to the Appellate Division’s determinations unless they discover clear evidence of an error. A claimant who is denied by the Superior Court has the option of appealing to the Georgia Court of Appeals within 20 days of receipt of the lower court’s decision. Although it is possible to win an appeal at this level, it does become more and more difficult for claimants to establish that an error was made once a case reaches the Court of Appeals.

Contact a Dedicated Workers’ Compensation Lawyer 

The medical benefits provided through workers’ compensation can make all the difference in an injured party’s ability to recover quickly without going into debt. Even if a claim has been denied, an injured party may still stand a good chance of receiving benefits through the appeals process, so if you live in Atlanta and sustained a work-related injury, please contact the law firm of Ted A. Greve & Associates, P.A. by filling out one of our standard contact forms and a member of our legal team will assist you in setting up a free consultation with an experienced workers compensation lawyer in Atlanta GA who can help you navigate the complex process of filing a workers’ compensation appeal.