Workers' Compensation Appeals

Workplace injuries in Georgia are generally governed by the state’s workers' compensation law. The workers' compensation system is an insurance system whereby the employee gives up his right to sue his employer for workplace injuries in civil court in exchange for a no-fault payout system if he is injured. There are benefits and drawbacks to this system--the main benefit is that it removes costly and complicated determinations of fault in favor of a simpler no-fault system where the employee will be compensated regardless of his own wrongdoing (in most circumstances). The drawback is that there are not as many forms of relief available to the employee as there would be in the civil court system, and the program is administered by a bureaucratic administrative agency instead of the civil courts.

But what happens if you are injured on the job and file a workers' compensation claim and that claim is denied? Do you have any recourse?

Each state is responsible for administering its own workers’ compensation system. As such, each state offers different benefits and requires different things from applicants. In Georgia, successful workers' compensation claimants will receive:

• Payment of all authorized medical, pharmacy, and physical therapy bills including travel to and from authorized providers
• Two-thirds of the claimant's average weekly wage, up to $575.00 per week
• Burial expenses for the claimant's spouse or children if he or she is killed in the workplace accident

The general procedure for filing a workers' compensation claim is as follows:

• Give notice to your employer no later than 30 days after the accident
• File a claim with the State Board of Workers' Compensation and send a copy to your employer and its insurance company
• Once your claim is received, it will be reviewed by your employer's insurance company and either approved or denied.

There are several reasons why workers' compensation claims are occasionally denied, including:

• Failure to report injuries promptly
• Failure to cooperate with your employer and treating physician
• Refusal to return to suitable employment
• Working elsewhere while receiving temporary total disability benefits
• Submittal of fraudulent information
• Refusal to take a drug tests
• Refusal to submit to a medical examination by the authorized treating physician.

If your claim is denied for any reason, you have the right to an appeal.

To do this, you must first request a hearing with the State Board of Worker's Compensation, where your case will be assigned to an administrative law judge. The judge will normally then proceed to schedule a mediation session between you and your employer in order to settle the issue without a hearing. If the mediation is unsuccessful, the Board will then schedule your case for a hearing, which is a trial-like proceeding where each side will argue its case.

If you are unsatisfied with the judge's ruling after your hearing, you can then appeal your case to the Appellate Division of the State Board of Workers' Compensation. If you are still unsatisfied with the result of your appeal, you may then appeal this decision to the Superior Court of the county where you are injured. Once you do this, your case will now be handled by the civil courts rather than the state board of workers' compensation, where you can continue to appeal each court's decision all the way up to the Supreme Court of Georgia, should you wish to take it that far.

Appealing a denied workers' compensation claim requires an expert to navigate you through the system and ensure that your interests are adequately represented. If your workers' compensation claim has been denied, contact the attorneys at Slappey & Sadd for a free consultation by calling 404.255.6677 or by sending us an email through our online contact form. We serve the entire state of Georgia, including the following locations: Atlanta, Decatur, and Marietta.