Appealing a Workers’ Compensation Decision in Fort Oglethorpe

Injuring yourself at work can be difficult to deal with, especially when you add in the headaches of dealing with workers’ compensation claims, denials, and appeals. Most employees should be entitled to benefits, but many get denied nonetheless.

Employers purchase workers’ compensation insurance from companies that operate to make a profit, so the insurance companies often seek to keep costs low by denying claims whenever the company can feasibly create a case for doing so. Fortunately, if you need to appeal a denial in order to receive benefits, there are avenues for appealing a workers’ compensation decision in Fort Oglethorpe, as well as skilled workers’ compensation lawyers ready to help you do so.

Mediation to Come to An Agreement

In many cases, the first stage of appealing a workers’ compensation decision in Fort Oglethorpe involves a mediation session between the employee and the insurer. A mediator is a neutral third party who works to devise a plan acceptable to both parties.

It should be noted, though, that mediators do not have authority to issue binding decisions. This means that if the mediator is unable to facilitate an agreement that both parties accept, the existing decision remains in place.

The Administrative Hearing

If a workers’ compensation claim is denied or benefits are wrongfully discontinued, the affected employee may request an administrative hearing at the State Board of Workers’ Compensation. This proceeding is conducted much like a trial, and an administrative law judge would take evidence from both sides before issuing a decision.

It is important to secure and present all evidence for a claim at this hearing, because any future appeals are likely to be based on the factual record established at the administrative hearing. While the State Board does not require claimants to be represented by an attorney at the hearing, insurers will certainly be represented by legal counsel and injured workers may need assistance from a lawyer to present their claims properly.

The Appellate Division

If either the claimant or their Fort Oglethorpe insurer is not satisfied with the administrative law judge’s decision on a workers’ compensation case, they may appeal the case to the Appellate Division of the State Board within 20 days. In most cases, a three-judge panel reviews the decision based on the written legal briefs provided by each party.

If requested in a timely fashion, the appellate panel may hear oral arguments, but the panel generally will not hear new testimony or accept any additional evidence. However, the appellate panel may remand the case to the administrative judge for additional evidence. The panel may also reject or affirm the judge’s findings, as well as the conclusion based on those findings.

Appealing to the Courts

Both parties have the option to further appeal the Appellate Division’s findings to the county superior court. Beyond that, a case may be appealed to the Georgia Court of Appeals and then the state Supreme Court. At each additional level, the grounds for appeal become narrower. In addition, the formality of the proceedings increases, and the need to follow proper procedure becomes even more paramount.

Get Assistance Appealing a Fort Oglethorpe Workers’ Compensation Decision

Workers’ compensation claims necessitate accurate interpretation of both laws and insurance provisions, both of which are often quite complex. As such, an experienced workers’ compensation attorney may serve as a valuable ally when appealing a workers’ compensation decision in Fort Oglethorpe.

While the process may seem daunting and often takes some time to resolve, the appeals process may enable you to receive the full benefits to which you are entitled under the law. Workers’ compensation is designed to protect injured workers, and thorough appeals often enable this system to provide the benefits workers need to move forward with their lives after an injury.