What does 'controverted' mean in workers' comp?

In the context of workers’ compensation, “controverted” refers to the act of disputing or challenging an employee’s claim for benefits. When an employer or insurer controverts a claim, they formally assert that the injury or condition is not compensable under workers’ compensation laws, or they dispute specific aspects of the claim, such as the extent of the injury, the necessity of medical treatment, or the causal relationship between the injury and employment. This is typically done by filing a notice to controvert with the workers’ compensation board. The employee should be mailed a copy of the notice to controvert.

The Georgia Workers’ Compensation Act provides specific rules for controverting claims. An employer has up to 81 days to controvert a workers’ compensation claim if they have voluntarily started paying benefits to the injured worker. This timeline is derived from the provisions of O.C.G.A. § 34-9-221(h), which states that if compensation is being paid without an award, the employer may controvert the claim within 60 days of the due date of the first payment of compensation. Since the first payment is due within 21 days of the employer’s notice of the injury, this results in a total of 81 days from the date of notice to file a notice to controvert

Controversion can also involve disputes over specific medical treatments or benefits. For instance, an employer may question the reasonableness or necessity of certain medical treatments, but this does not necessarily mean the entire claim is controverted. Additionally, if an employer fails to pay all compensation due at the time of filing a notice to controvert, the notice may be deemed invalid .

If benefits are controverted, the injured worker has the right to request a hearing before an administrative law judge to resolve the dispute. The judge will review the evidence and testimony presented by both parties and issue a decision on the contested issues. If the judge finds in favor of the injured worker, the employer or insurer may be required to pay the disputed benefits, as well as any penalties or attorney’s fees associated with the dispute.