Georgia’s workers’ compensation is adversarial to say the least. We watch as insurance companies reject work injuries that are clearly legitimate. We watch as insurance companies pay less than the full value of the work injury. And we also watch insurance companies acquire medical opinions that say the injured employee was not injured at work—so that they can pay the least amount possible. So, what can be done if your claim is rejected or underpaid?
Appealing a Denied Claim
The State Board of Workers’ Compensation (SBWC) reviews any disagreements over workers’ comp claims in Georgia. If you want to challenge an insurance agencies refusal to affirm your claim, then your first step is to file a “notice of claim” form within one year of the injury. Sometimes mediation is ordered by the judge or requested by the insurance company. If no agreement is made then you continue through the appeals process and schedule a hearing. A judge makes a determination and if either party does not agree, the case is taken to the appellate division of the SBWC. If the SBWC does not rule in your favor, you can appeal to the Georgia courts within 20 days of the SEC’s decision.
File a Workers’ Compensation Complaint
The enforcement division of the State Board of Workers’ Compensation handles the complaint process for: a) anyone who knows or suspects someone has committed a fraudulent act b) anyone who is not in compliance with the Georgia Workers’ Compensation Act (they fail to have proper insurance coverage). As an injured worker, if you have unimpeachable evidence that your claim was rejected because of an irregularity or fraud, then you can request a complaint from from your local workers’ compensation office and start the complaint process.
2010 Georgia Code§ 34-9-24 (d) “In the absence of fraud or malice, no person or entity who furnishes to the Board information relevant and material to suspected fraud or noncompliance with the workers’ compensation laws of this State shall be liable for damages in a civil action or subject to criminal prosecution for the furnishing of such information.”
Reopen a Claim
Workers’ compensation cases can be reopened even after settlement. This is key for employees whose disability or occupational disease is worsening. Every state sets its own statute of limitations on reopening a claim and in Georgia, it is one year after injury.
Georgia workers have valuable rights in relation to workers’ compensation. If you are an injured worker with a rejected or undervalued claim, there is no better time than now to seek the advice of an experienced workers’ comp attorney. Legal counsel with experience in workers’ compensation will help you simplify the process and make sure you get what is owed to you.