Why Was My Workers' Comp Claim Denied?

In the state of Georgia, most employers are required to carry valid workers’ compensation insurance to cover any workplace injuries. While most injury types are fully covered under this form of insurance, however, the insurance companies may not always be willing to approve your claim – even when it’s completely valid.

At Herbert Chestnut & Associates, our workers’ compensation attorneys have spent over 60 years helping claimants throughout Marietta, Cobb County, and surrounding areas. AV Preeminent-rated by Martindale-Hubbell and three-time winners of Workers’ Comp Attorney of the Year, we have the skills and knowledge to help you pursue a fair settlement after your compensation claim denial.

Here are some of the most common reasons for claim denial:

  • No one else saw the incident that caused your injury. While you can’t help how many witnesses saw your workplace accident, insurers often do not approve claims unless there are plenty of verifiable witnesses involved. Speaking to your supervisor and co-workers immediately after the accident, or as soon as you discover the injury, can help mitigate this problem.
  • You didn’t file the claim in time. The time limits for filing a workers’ compensation claim in Georgia are incredibly strict. If you do not report your injury within the first month, it can be difficult to receive benefits later on, and your claim may ultimately be denied.
  • Your employer disputes the terms of the claim. Although employers do not face any direct consequences when you file a workers’ comp claim, their insurance premiums may rise slightly in the aftermath of a settlement. This means your employer could be motivated to claim that your injury didn’t occur at work, and that you do not qualify for benefits.
  • Your medical records show the presence of illegal drugs. If there are any illegal drugs in your system when you’ve been admitted for a work injury, the insurer may deny your claim outright, without even looking at the circumstances.
  • There are discrepancies in your accident report or statement. When filing a workers’ comp claim, you will need to provide a detailed report of the accident, and the insurer may ask you to give a written or recorded statement too. If there are any inconsistencies in your story, that alone could prompt an insurer to deny your claim.
  • There’s insufficient evidence for a stress claim. Georgia does not allow for “pure stress claims,” or claims solely based on a mental injury. However, if you've experienced long-term physical effects in conjunction with stress, you may be eligible to file a claim – provided that you can show a wealth of evidence to back it up.
  • You had a pre-existing condition. Although pre-existing conditions shouldn’t be considered an overriding factor in a work-related injury, the unfortunate truth is that insurers will see this as another reason to deny your claim. More specifically, they will argue that the injury did not occur at work, or that your pre-existing condition is what primarily caused the injury.

Committed to Protecting Your Rights

No matter why the insurance provider denied your initial claim, our attorneys at Herbert Chestnut & Associates will do everything in our power to help you secure a fair recovery for your work-related injuries. With compassion and care, our legal team will stand by your side and help you negotiate the appeals process, and take the claim to court if it becomes necessary.

For more information about our legal services, call (770) 661-0091 today!