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Workers’ compensation denied my claim. Now what?

Denials of workers compensation claims are far too common. Fortunately, in our experience, the majority of denied claims ultimately will result in a settlement or the payment of benefits. Every case is unique and an experienced lawyer will be able to evaluate the value of your case, even if your case has been denied. The point is that you should not give up just because the insurance company has not accepted your case. It is very common for workers compensation insurance companies to deny claims on week or dubious legal grounds. The insurance company is a business, and their ultimate goal is to pay you as little as possible. it's their hope that you will not hire a lawyer and that you'll give up when you get the notice that your claim was denied. You should not fall for this tactic, because even denied claims are often very valuable.

Here are some of the common reasons for denials we see in workers compensation cases:

  • Your case was denied because you have a pre-existing condition. Insurance companies will often deny your case because of a pre-existing condition. This is a very difficult defense for the insurance company to win. The law in Georgia says that an aggravation of a pre-existing condition is considered a new accident. It really does not matter that you had a pre-existing condition. As long as work contributed to making the pre-existing problem worse, you should be owed workers compensation benefits. Our firm frequently handles and wins these types of cases.
  • Your case was denied because they say you were not “on the clock” during the injury. We often see cases where the insurance company will try to deny coverage to someone who is injured at lunch, during a bathroom break, or while traveling for work. Workers compensation law says that you are in the course of your employment as long as you were doing something related to your employment. While these cases can often involve complicated legal rules, the scope of coverage for workers compensation is very wide. workers comp is meant to cover you not only while you're directly performing work duties, but also while you're doing anything incidental or related to your work. If you have had your case denied on the basis that you were not “on the clock” during the injury, you should immediately contact a lawyer. Our firm recently handled a case in front of the Georgia Supreme Court where the insurance company tried to deny our client benefits because she was injured by a lunch break. The supreme Court has agreed with us that the injured worker could not be denied workers compensation benefits just because she was not directly performing work duties when she got injured.
  • If you are injured because you trip and fall or pass out, the insurance company might deny your claim on the basis that your injury was "idiopathic". This simply means that your injury was caused by a reason personal to yourself that had nothing to do with work. These types of defenses are especially difficult for insurance companies to win. In most cases, the circumstances of your employment are going to contribute to your injury in some way. Insurance companies will often try to use this defense, even when they know it's very unlikely that they could win at a hearing. Although every case is unique, you should contact a lawyer if the insurance company says your accident is "idiopathic."
  • Your case was denied because you had a positive drug test. It seems that many insurance companies will automatically deny your claim if you have a positive drug test after the accident. Workers’ compensation says that you are not entitled to benefits if intoxication is the cause of the accident. Just because you fail a drug test, that does not mean that your accident was caused because you were intoxicated. If your case was denied because of a positive drug test, you should immediately contact a lawyer. It is common to see cases denied because of a positive test for marijuana. However, the metabolites for marijuana can stay in a person's body for over a month even when they are not intoxicated. The same is true for many other drugs. A lawyer can gather the medical evidence necessary to prove that your accident was not the result intoxication.

these are just a few of the common defenses that we see come up frequently in workers compensation cases. Our firm has experience dealing with every type of defense that can come up in a workers compensation case. you should not get discouraged just because your case has been denied. Denied cases can be worth just as much or even more than accepted workers compensation cases. If your workers compensation case has been denied, please call our firm at 770-886-3030.

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