When can an Employer/Insurer Controvert a Claim after Initial Payment?

Under Georgia law, when an Employer/Insurer initially accepts a claim and commences income benefits, it can still challenge or controvert the right to weekly benefits if the Employer/Insurer files a notice to controvert within 60 days of the due date for the first payment of benefits. It can not controvert after this 60 days unless it can show newly discovered evidence or a change in condition.

I recently took over a claim where the Employer/Insurer filed a notice to controvert far past the 60 day time limitation based upon purported “newly discovered evidence.” This claim involved an employee who had allegedly falsely indicated in an employment questionnaire that she had not had a prior back injury.

Upon reviewing the file, however, it was apparent that the evidence was not newly discovered. The employee reported the prior injury to her first medical provider after the most recent work accident. Employer/Insurer could not argue newly discovered evidence, and their controvert was made without legal basis (they could not show a change in condition either). We were able to settle the claim for a substantial amount based upon this error.

It is always important to look at the specific facts of every case to determine if the Employer/Insurer in fact suspended benefits upon legal grounds.