Riverdale Workers’ Compensation Appeals Lawyer
When you develop a work-related illness or suffer an injury on the job, you are entitled to receive workers’ compensation benefits if your employer participates in the program. Sadly, many companies and their insurers fight legitimate workers’ compensation claims to avoid paying injured workers.
If your employer’s insurer denied your claim, you have the right to appeal with a skilled workers’ comp attorney. Seek help with your claim from a Riverdale workers’ compensation appeals lawyer to fight for the compensation you are entitled to.
What Are Common Reasons a Claim Might Be Denied?
An employer’s workers’ compensation insurer must inform an employee of its decision to accept or deny a claim within 15 days of receiving it. If the insurer denies the claim, it must state its reasons.
There are many reasons an insurer might deny a claim. These include:
- Employer or the insurer believes the worker is faking an injury or illness
- Employer or the insurer believes the worker’s condition is not job-related
- Employer or the insurer believes the worker is fit to return to work
Disputes about an employee’s readiness to resume their duties are common, as are differences of opinion about the degree of a worker’s permanent disability. For instance, disputes sometimes center around the amount of the employee’s weekly benefit.
Any individual who receives a claim denial should contact a Riverdale lawyer right away. Employers and their insurance companies might take a more reasonable stance if they know an employee intends to fight to protect their rights.
Presenting the Worker’s Side to an Administrative Law Judge
Workers who are dissatisfied with an employer’s decision must ask for a hearing before an Administrative Law Judge (ALJ) by filing a WC-14 form.
If the worker and the employer agree, they could participate in mediation prior to an ALJ hearing. The mediator has no authority to issue decisions, but they could help the parties come to an agreement. However, if a mediation does not result in an agreement, or if the parties do not choose to engage in mediation, there will be a hearing before an ALJ.
At this hearing, the ALJ examines records and hears evidence from the worker and the insurance company. This is the only opportunity a worker has to present documents and testimony supporting their side, so it is important that they have legal representation. An experienced Riverdale attorney could present any available evidence for the appeal that supports the worker’s claims for compensation.
Options if ALJ Hearing is Unsuccessful
Even if the ALJ’s ruling is unfavorable, the worker could continue to pursue their claim. If the worker’s Riverdale attorney believes the ALJ made a legal error, they could appeal to the Worker’s Compensation Review Board. According to the Official Code of Georgia Annotated §34-9-103, the Board only considers the record of the case presented to the ALJ.
If the employee disagrees with the Board’s decision, they might appeal to the Superior Court. However, the court only considers the existing records and will not hear testimony or any new evidence. Once a case reaches the courts, a worker is likely to be successful only if the ALJ made a clear error.
Trust a Riverdale Workers’ Compensation Appeal Attorney
Injured workers have a right to workers’ compensation benefits and to fight any denial of benefits. However, it is unwise to take on an insurer alone.
Appealing a denied claim requires deep knowledge of the process and robust litigation skills. A Riverdale workers’ compensation appeals lawyer has the experience you need to prevail. Make an appointment for a case review as soon as you receive a denial to begin fighting back.