Why Was My Workers’ Compensation Claim Denied?

You were injured on the job, so you went to the hospital, were treated for your injury, and then released.  Your doctor placed you on work restrictions and your employer filed a claim with its workers’ compensation insurer.  You then receive a notification in the mail that your claim has been denied. Why?

Well, insurance companies go out of their way to deny claims using whatever baseless reasoning is most difficult to disprove. That doesn’t mean that what they’ve done is legal. It only means that you’re going to have to fight for the compensation you are owed under the law. In this article, we’ll take a look at common insurance company tactics for denying valid workers’ compensation claims.

Workers’ Compensation Tricks of the Trade 

Georgia workers’ compensation insurance companies will use the gray area between allegation and fact to try to slow down your claim.  If there is any uncertainty in your case, then the insurance company will try to exploit the uncertainty to try to deny your claim.  This will then force you into disproving the insurance company’s claim. By the time you’ve done that, they’re already onto another argument exploiting some other uncertainty. The exploitation of uncertainty is how a workers’ compensation insurance company can logjam claims in the workers’ comp system for months and leave injured workers without income. They then come in with a lowball offer to try to get you to settle your case and go away.

Common reasons for denying a claim include:

• Your injury was unwitnessed and therefore could have been self-inflicted
• You failed to report your injury immediately after it occurred
• There’s an apparent discrepancy between the incident report and your medical records
• Your medical records indicated that there were illegal drugs in your system
• Your claim was filed after you were fired or laid off
• You failed to give an official statement or provide consent for medical records
• Your injury is the result of a pre-existing condition and therefore is not work-related
• Your injury was not related to the duties of your job, but the result of fooling around or horseplay

In each of these cases, your claim may be more difficult to file but you may still be eligible for compensation under Georgia workers’ compensation law. For example, if you are injured at work, go to the hospital or clinic, and the medical provider finds marijuana in your system, the insurance company may try to argue claim that your accident was the result of drug intoxication. However, there are very specific requirements under Georgia law for the employer and insurance company to try to use intoxication as a defense.  The positive drug test may make your claim more difficult to win, but not impossible, and that’s precisely what the insurance company wants: To make the workers’ compensation process as difficult as possible.  An attorney is able to help you navigate the workers’ compensation minefield to achieve a positive resolution of your claim.

Talk to a Workers’ Compensation Lawyer in Decatur, GA 

If your workers’ compensation claim is in a logjam due to the insurance company delaying or denying the claim, then it may be time to hire a Decatur workers’ compensation attorney. Call O’Connell Law Firm, LLC today to discuss your situation and learn more about how we can help.