A work injury or illness can bring everything to a screeching halt. Your productivity on the job as well as your ability to fulfill your obligations at home may be on hold while you recover.
This can mean a devastating loss of income that can be difficult to overcome, especially with medical bills coming in. Fortunately, workers’ compensation insurance benefits through your employer can provide you with funds to cover a portion of your lost income and any medical bills related to your injury or illness.
However, what happens when you receive a notice from the insurer that they have denied your claim? It happens. Workers’ compensation insurers, like any insurance company, are businesses trying to minimize any payouts they make. Therefore, it is important to understand the legitimate reasons why your claim may be unsuccessful.
Reasons an insurer might reject your claim
When you receive a letter from the insurance company after filing your claim, it is important to read the information carefully. The letter should explain the reasons why they denied your claim. The most common reasons include the following:
- You missed the deadline for reporting your injury to your employer.
- You did not file your claim for benefits within the allotted time after your accident or the onset of your illness, or you filed the claim incorrectly.
- Your employer reported to the insurer that he or she does not believe your injury or illness is work related or that it was the result of horseplay on the job.
- The injury or illness you suffered is not covered under Georgia’s workers’ comp law, such as certain psychological illnesses not related to an injury.
- You did not receive medical treatment for your condition or you did not follow doctor’s orders.
- You did not include enough evidence that the injury was work related.
Even if you have received a notice that the insurer has denied your claim, this doesn’t necessarily mean you are out of options. If you believe the insurer’s reasons for rejecting your claim are unfounded, you have the right to appeal the decision. In fact, no matter the reason for the denial, it may be smart to seek legal advice as early as possible. With the help of an experienced attorney, you can improve your chances of a successful appeal.