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The workers’ compensation system exists to help injured employees manage their finances after a work-related injury, but the claims process isn’t exactly straightforward, and complexities arise very frequently for claimants across all industries. Claim denial happens for many reasons, and it’s vital for employees to understand how the workers’ compensation system works in case they must rely upon it later after a job-related injury.

At Cruz & Associates, we understand the frustration and distress that comes with a denied workers’ compensation claim. Our history of handling workers’ compensation cases for past clients means we have a wealth of experience at our disposal to handle even the most difficult workers’ compensation cases. Consider the common causes of denied claims to protect yourself, and get in touch with our team if you would like more information.

Common Reasons for a Workers’ Compensation Claim Denial

The most common reason for a denied workers’ compensation claim has to do with the timeliness of filing the claim. It is crucial for injured employees to report their injuries to their employers as soon as possible. Workers’ compensation benefits not only require meeting specific filing deadlines, but any delay on the part of the employee weakens his or her case during the review process. Employers also have an obligation to report an employee injury to their workers’ compensation insurance agency in a timely manner as well.

Disputed Workers’ Compensation Claims

The next most common reason for denied workers’ compensation claims is the employer disputes the employee’s statements as to how the injury or illness occurred. For example, an employer may deny that an employee’s injury occurred during the course of work or otherwise does not qualify for a workers’ compensation claim. State laws sometimes come into play when  they exclude specific types of illnesses or injuries from workers’ compensation claims. Additionally, an employer may argue that an injury or illness is not severe enough to warrant a claim.

If an employer disputes a workers’ compensation claim, the injured employee will need to gather additional evidence to advance the claim through the appropriate channels. This could include gathering statements from eyewitnesses who saw the injury occur at work, or medical experts who can testify as to the severity of an injury. Finally, the employer’s workers’ compensation insurance carrier may deny an employee’s claim for any number of reasons.

Appealing a Denied Workers’ Compensation Claim

The workers’ compensation system allows employees to appeal denied claims under certain conditions. Appealing requires meeting strict filing deadlines and gathering the necessary documentation for making a case. An appeal will likely lead to a hearing at Georgia’s State Board of Workers’ Compensation, where an administrative judge will hear both sides of the case and render a decision based on the state’s workers’ compensation laws and the facts provided.

Navigating the workers’ compensation claims process can be difficult even under the best circumstances, and a denied claim can create a stressful and frustrating situation for an injured employee. The right attorney can make a world of difference in the outcome of a workers’ compensation claim and any necessary appeals. At Cruz & Associates, our attorneys cater exclusively to auto accident and workers’ compensation clients, so injured Georgia employees can rest assured knowing we have the resources and experience necessary for handling even the most complex workers’ compensation claims. Contact us today to schedule a free case evaluation. We’ll review the facts of your case and let you know how we can help.