Calvin Smith Law - The Injury Lawyers

Why Are Denial Rates So High for Workers’ Compensation?

denied workers compensation claim

Georgia employees face some of the highest denial rates for Workers’ Compensation. The national denial rate averages at around 7% while in Georgia this denial rate has topped 40% at times in recent years. In the first rounds of claims, our firm has found that as many as 67% of Georgias’ workers comp submissions are denied.

While most employers are required to provide Workers’ Compensation to their employees, there are exceptions as well as numerous circumstances that can cause an employee’s claim to be denied. Whether you are looking to file a claim or appeal a recent denial of an application for benefits, this article will help you increase your chances of a successful workers’ compensation case.

Our talented Georgia workers comp lawyers will review your claim, answer questions about your claim, and help you navigate the process.

Common Reasons for Denial

Once a claim is filed, there are a few common reasons why it could be denied. By being aware of these reasons, you can improve the likelihood of a successful claim.

  • The injury occurred while acting outside of the scope of job-related duties
  • The injuries are determined to be caused, in part, by the claimant’s intentional neglect
    • This includes being under the influence of alcohol or drugs at the time of injury
  • The medical care you received as a result of the injury is out-of-network and therefore not covered by your employer’s workers’ compensation insurance
    • You must also comply with medical requests made by the insurance company
  • No medical treatment was sought
  • Missed deadlines
  • The deadlines for filing W/C claims are strict. You must report your injury to your employer within 30 days of the time of the incident or the time when you noticed the injury. After this, your employer is required to report the claim to the insurance company within 7 days of their actual knowledge of the injury.
  • Insufficient/incomplete information on the application
  • Injury deemed not severe enough
    • Mental health is not covered by GA Workers’ Compensation Insurance unless you have a physical injury.
  • The employer/insurance company disputes the claim
    • They may dispute the amount of benefits owed or whether the injury was work-related
  • No witnesses

If You Want the Best Chance of Success in Your Claim, Contact Our Office

Our Georgia Workers’ Compensation lawyers will provide you with essential assistance in the process of filing a W/C claim, including:

  • Reviewing your claim
  • Filling out forms completely and accurately
  • Making a strong case in the absence of witnesses
  • Handling disputes with employers and insurance companies
  • Filing appeals after a denial

If you’re unsure how to proceed with your workers comp claim, reach out today! An initial consultation is offered at no cost for new clients. While high rates of W/C denials may seem discouraging, our skilled attorneys will work with you to make sure your case has the best chance of success.

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