California state and federal workers’ compensation laws require most employers to provide workers’ compensation insurance coverage for their employees so that they are eligible for financial compensation in the event of a workplace injury. Employees are generally entitled to recover compensation for medical expenses, including rehabilitation and lost wages related to their work injuries.
Unfortunately, employers and insurance companies do not always make financial recovery easy for employees because it benefits them to deny claims or underpay them. If you have been denied the benefits that you deserve, you may challenge the decision to deny your claim, and a workers’ compensation attorney will make the appeal and financial recovery process easier and more productive.
Reasons Your Claim Was Denied
There are several reasons your claim may have been denied, including the following:
- There were problems with the claim you submitted. Your claim may be denied because it contained errors or omissions, or because it was incomplete.
- Your employer and/or insurance company disputes your claim because of certain facts. Sometimes employers and insurance companies will argue that your injury did not occur at work, you were not injured, your injuries were related to a pre-existing condition, you were not injured to the extent that you claim, or you were under the influence of drugs or alcohol when you were injured.
- Your claim was not timely. In California, injuries should be reported to employers, and claims should be filed within certain time parameters. Claims may be denied when injured employees do not report their injuries and file their claims within those time parameters.
- You did not receive medical treatment. When injuries are significant enough to receive workers’ compensation benefits, medical care is typically necessary, and benefits are denied when you do not submit evidence of receiving medical treatment.
After Your Claim Has Been Denied
If your claim has been denied, you have the right to challenge that decision in California. Many times claim denials are the result of not providing necessary information or evidence to substantiate your claim. Although you may appeal the decision to deny your claim on your own, challenging a denial is an uphill battle, and you have a better chance of a successful appeal when you have an experienced advocate fighting for your compensation.
A workers’ compensation attorney will review your claim and reason for denial. Your attorney will then help you take the necessary steps to successfully challenge the decision to deny your claim.
Preparing To Challenge The Decision To Deny Your Claim
After determining the reason for denial, it is important to prepare for your appeal. If the facts of your claim are disputed, it will be important to gather evidence that proves your version of the facts. This may include witness statements, doctors’ opinions and reports, and further medical evaluation.
Once the necessary supporting information and evidence are gathered, you may challenge the denial by filing the appropriate appeal paperwork with the state of California.
If your claim has been denied for other reasons such as failing to timely notify your employer or not seeking medical treatment, you will need to address those reasons and provide an appropriate response. Sometimes injured employees do not notify their employers or seek medical treatment because they did not initially recognize the severity and extent of their injuries.
This often happens when employees experience a delayed onset of injury symptoms or when employees wrongly assume that their injuries will eventually go away on their own.
Settlements, Hearings, And Trials
Depending on the facts and circumstances of your case, challenging your denial may involve settlement negotiations, hearings, and a trial. The order of events and appropriate filings along the way can be very confusing and missing deadlines can be fatal for your case, but a workers’ compensation attorney will help to ensure that your right to appeal is protected by meeting all deadlines and filing requirements.
Challenges are frequently settled prior to trial, especially when you have a skilled negotiator advocating for your recovery.
After A Trial Challenging Your Denial
Even after the judge makes a trial decision, the fight for your compensation may not be over. This is because either party may file a petition for reconsideration if they do not agree with the judge’s decision.
The process to recover workers’ compensation after a denial can be complicated and exhausting. Unfortunately, when employers and/or insurance companies work against injured employees seeking workers’ compensation, employees are at a disadvantage, but a good attorney can help to level the playing field and achieve the compensation that you deserve.