If you suffered a work-related injury, you’re relying on workers’ comp to help you and your family make it through a difficult time. But what happens if the insurance company denies your claim? In Georgia, you have the right to appeal the insurance company’s decision.
Here’s how to go about that:
Appeals about denied workers’ comp claims are handled by the State Board of Workers’ Compensation (SBWC). The first step to do if your claim has been denied is to request a hearing with the SBWC by completing and filing the WC-14 form. Once your form is received and reviewed, you’ll be given a hearing date. The hearing is less formal than a full trial but is still a fairly complex process. Although you’re legally allowed to represent yourself at the hearing, it’s likely to your advantage to pursue professional representation for your case such as Castan & Lecca. At Castan & Lecca. We have experienced workers’ compensation attorneys who are familiar with the tactics of the insurance companies. Some of our attorneys have worked defending the insurance companies, so their wealth of knowledge can help when it comes to fighting for your rights.
Prior to the hearing, the parties may agree to mediate the claim which is to try to reach a settlement outside of court before going to a hearing.. The mediation process involves you, your employer, your employer’s insurance rep, and any attorneys from the respective parties sitting down with a mediator to dialogue and craft an acceptable arrangement to solve the dispute. If mediation is effective, the case won’t proceed to the hearing. Usually, this would be the best case scenario–saving both time and money on all sides and allowing you to start receiving benefits more quickly. Sometimes, though, it’s not possible for parties to come to an agreement, so the case will proceed to the court hearing.
The court hearing is held by an administrative law judge who hears the arguments of all parties involved, examines the evidence presented, and hands down a decision within 30 days of the hearing. The judge’s verdict is mailed to the parties involved, so you’ll receive a notice of the decision by mail.The attorney’s at Castan & Lecca will make sure that you are fully prepared before you go to your hearing.
If you disagree with the judge’s decision, you have 20 days to file an appeal for SBWC appellate board review. The insurance company could also appeal the judge’s decision. The appellate board reviews all the information presented at the hearing as well as written statements given by both parties. Your attorney can also request an in-person hearing if that seems likely to advance your case. Typically, the appellate board will render a decision after they’ve reviewed all the information, but occasionally, they might send the case back to the judge for reconsideration. The appellate board can confirm or overturn the judge’s decision.
If the results are still not favorable for you, you, once again, have 20 days to file an appeal with the Georgia court system in the county where you were injured.
That’s an overview of how the appeal process works if you’re denied workers’ comp. We’re here to help answer any questions you have and to help you get the protection and care you need, so please reach out to us!