Appealing a Workers’ Compensation Decision in Tucker

The workers’ compensation program exists to ensure people hurt on the job receive free medical care and payments to help make up for the wages they may lose when they cannot work. Every business in the state with at least three employees must participate in the workers’ compensation system.

Unfortunately, companies and their insurers work hard to keep their costs down, sometimes at their employees’ expense. If you have suffered a work-related injury and your employer’s insurance company has denied your claim, you have the right to appeal. However, appealing a worker’s compensation decision in Tucker is a complicated process. Workers benefit when they secure legal representation early.

Reasons an Employer Might Deny a Claim

If an employer does not believe a worker has an injury or suspects it was not job-related, they could deny the employee’s workers’ compensation claim. Although the employee may receive medical treatment under the program, they would not receive any indemnity benefits under these circumstances, which are weekly checks an injured employee receives when they are unable to work due to an on-the-job injury.

If an employer acknowledges a worker’s injury, they still could deny an aspect of the claim. For example:

  • There may be a disagreement about the amount of the employee’s weekly indemnity payment;
  • An employer and a worker may disagree about whether the employee’s injury has healed sufficiently to allow the employee to return to their regular duties;
  • An employer might wish to prevent an employee from switching doctors; and/or
  • An employee’s doctor might certify that the employee has a partial disability, but the employee feels that their disability is total.

Workers in Tucker who are unhappy with an employer’s decision on any of these workers’ compensation issues may appeal the decision. With an Administrative Law Judge (ALJ) presiding, the hearing is the worker’s only opportunity to present testimony and evidence. Therefore, it is essential that a worker present their best case to the ALJ. For that reason, it is advisable for the worker to be represented by an attorney at the hearing.

Workers’ Compensation Hearing Procedures

A worker may request a hearing by submitting Form WC-14. According to the Official Code of Georgia Annotated § 34– 9–102, the ALJ must schedule a hearing between 30 and 90 days of receiving the request.

Both parties may sometimes agree to engage in mediation before a hearing. In that case, the mediator attempts to facilitate an agreement between the worker, the employer, and the employer’s insurer. However, the mediator does not issue settlements or decide whether the worker is entitled to benefits.

If the parties decide not to participate in mediation or it is unsuccessful, the hearing goes forward. Both parties may present evidence at the hearing and cross-examine the other party’s witnesses. The assistance of a lawyer could be very beneficial at these hearings, as they are skilled in presenting evidence in the most persuasive manner and adept at questioning witnesses.

The ALJ must issue a written decision within 30 days of the hearing. The ALJ decides whether the worker is entitled to the benefits they seek and the value of the benefits the employer owes the employee, if any.

Appealing an ALJ Decision

If an ALJ decides against a worker, further appeals are possible, but the likelihood of success diminishes, as the appellate bodies make their decisions based on the record that the ALJ compiled. Unfortunately, they do not look at new evidence or hear testimony from witnesses.

However, if the ALJ made an error or misapplied the law, an appeal to the Worker’s Compensation Board could be successful. If the Worker’s Compensation Board rules against the worker, the worker’s attorney might appeal to the superior court and then to higher courts. Courts typically overturn an ALJ’s decision only when they find a clear error in the record.

Retain Experienced Legal Counsel when Appealing a Workers’ Compensation Decision in Tucker

You have a right to the benefits workers’ compensation provides, and employers may not interfere with those rights. Appealing a workers’ compensation decision in Tucker is a way for injured workers to stand up for themselves.

However, the rules are complicated, and pursuing a successful appeal requires skills.  As soon as you suspect that your employer might deny your worker’s compensation claim, schedule a consultation with a knowledgeable local lawyer to get an aggressive advocate working for you.