Understand the process to appeal an unfair denial of your workers’ comp benefits in Georgia
If you were injured at work or developed an occupational disease in Georgia and your workers’ comp benefits were denied, delayed, or unfairly reduced, you don’t have to accept it as the final word. Georgia workers have the right to dispute decisions through a legal process called adjudication—and understanding how it works is the first step in protecting your rights.
In this article, we’ll explain what adjudication is, who can file for it, common reasons workers request adjudication, and what you can expect during the process.
If you have individual questions about your workers’ comp claim or want help appealing an unfair denial of benefits, reach out to the knowledgeable Atlanta work injury attorneys at 91proƵ & Holder to schedule a free consultation.
What is adjudication in workers’ comp?
In Georgia workers’ comp, adjudication is the legal process used to settle a dispute in a claim. If there’s a disagreement—like whether your injury is work-related, how much you should be paid, or what medical treatment you need—it can go to adjudication.
This means the case is brought before a workers’ compensation judge with the State Board of Workers’ Compensation (SBWC), who listens to both sides, reviews evidence (like medical records or witness testimony), and makes a decision. It’s similar to a court hearing, but it focuses specifically on workers’ comp issues.
The process can be rather intimidating, so many injured workers get help from a workers’ compensation attorney to make sure their side of the story is clearly heard and their rights are protected during the adjudication process.
Who initiates a workers’ comp claim adjudication?
In Georgia, it’s usually the injured worker or their attorney who initiates adjudication by filing a with the State Board of Workers’ Compensation. This form is used to begin the process of appealing a decision when there’s a disagreement with how the employer or their insurance company is handling the claim.
Filing Form WC-14 triggers the next step in the legal process: a request for a hearing before a workers’ comp judge. It’s the first official move in asking the court to step in and resolve the conflict.
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Reasons a worker might file a workers’ comp claim adjudication
The unfortunate truth is that workers’ comp insurance adjusters often deny valid claims simply to save money—even when injured workers are clearly entitled to benefits. They take advantage of the fact that many workers aren’t aware of their rights and may not even know they can dispute the adjuster’s decision.
There are many valid reasons why an injured worker in Georgia can (and should) file for a workers’ comp claim adjudication after an unfair decision on their claim, including:
- The claim was denied completely. For example, let’s say a factory worker at a battery manufacturing plant files a claim for lead poisoning from long-term exposure on the job, but the insurance company denies it, saying the illness wasn’t caused by work. Adjudication would allow the worker to present medical evidence and testimony to prove the lead poisoning was job-related.
- A repetitive stress injury isn’t being recognized. Conditions like carpal tunnel syndrome, tendonitis, or chronic back pain from repetitive tasks may be dismissed by insurers as “not work-related.” If the worker believes their condition clearly stems from their job duties, adjudication gives them a chance to prove it.
- Medical treatment is delayed or denied. A worker may need surgery or therapy that the insurance company refuses to approve. Through adjudication, the worker can submit a doctor’s recommendation and argue that the treatment is necessary.
- Disputes over indemnity benefits (wage replacement). Sometimes, the insurer may pay less wage replacement benefits than what the worker is entitled to, or they may stop indemnity payments altogether without a clear reason. Adjudication can help settle how much the worker should be receiving and for how long.
- The employer is pressuring the worker to return to work too soon. If a worker is still under light-duty restrictions from the authorized treating physician but the employer insists they can return to full duty, the worker may file for adjudication to challenge that decision.
- Disagreements over permanent disability ratings. After reaching maximum medical improvement (MMI), a worker might be assigned a permanent partial disability rating that they feel undervalues their condition. Adjudication allows them to contest the rating and seek a more accurate assessment.
In situations like these, filing for adjudication gives you a chance to have your case heard by a neutral judge who can make a fair decision based on the facts.
Having an experienced Georgia workers’ comp attorney on your side can make a big difference—they’ll help you prepare for the hearing, gather the right medical records, and fight to make sure you get the benefits you’re owed.
What happens after an application of adjudication in workers’ comp?
After a worker (or their attorney) files a Form WC-14 with the Georgia State Board of Workers’ Compensation (SBWC) to request adjudication, the legal process officially begins to resolve the dispute. This is what typically happens.
1. Notice of hearing
The SBWC will schedule a hearing date and send a notice to all parties involved—usually the injured worker, the employer, and the employer’s insurance company. Hearings are typically scheduled within 60 to 90 days of the request.
2. Discovery and evidence gathering
Before the hearing, both sides prepare their case. This may involve:
- Collecting medical records and wage information
- Taking depositions (sworn statements) from doctors, the worker, or witnesses
- Reviewing surveillance footage, employment records, or job descriptions
- Exchanging documents through the discovery process
3. Mediation (sometimes)
In some cases, the SBWC may require the parties to attempt mediation first—a meeting with a neutral mediator to try and resolve the dispute without going to a full hearing. If mediation is unsuccessful or waived, the case proceeds to a hearing.
4. The hearing
This is like a mini-trial, but it’s less formal. A workers’ comp judge (known as an Administrative Law Judge or ALJ) hears both sides, reviews all the evidence, and listens to testimony. The injured worker may need to testify about their injury and how it affects their ability to work.
5. Judge’s decision
After the hearing, the judge issues a written decision—called an “award”—within 30 days. This decision is legally binding and explains what workers’ comp benefits, if any, the worker is entitled to.
6. Appeal (if needed)
If either side disagrees with the judge’s decision, they can appeal it to the Appellate Division of the SBWC and finally the Georgia Court of Appeals. These appeals must be filed within 20 days of the rulings.
We cannot emphasize enough how crucial it is to have a local Georgia work injury attorney advocating for you throughout the process.
Insurance companies handle these claims every day, so they know the loopholes that can be used to minimize or avoid payouts. Having a skilled attorney on your side levels the playing field and helps ensure you don’t get taken advantage of when you need support the most.
Need help filing a workers’ comp claim adjudication in Georgia?
If you’re feeling overwhelmed, frustrated, or just unsure about what to do after being wrongfully denied the workers’ comp benefits you’re entitled to, we get it—that’s exactly why we’re here. Let our experienced Atlanta work injury attorneys stand up for you, simplify the appeal process, and fight for the benefits you need to heal and move forward.
Learn more about how we can help you with the workers’ comp claim adjudication process in Georgia by scheduling a free consultation with 91proƵ & Holder Workers’ Compensation Attorneys today.
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