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What to Do If Your Workers’ Compensation Claim Is Denied

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Posted By DAM Firm | January 20 2020 | Workers' Compensation

Workers’ compensation can be your outlet for financial recovery after suffering a serious injury in the workplace. It could provide the support you need to pay for medical expenses, lost income, and other costs during this difficult time. If your employer’s workers’ compensation insurance company denies your claim, however, you may feel at a loss as to what to do next. Do not accept the denial without a fight. You have the right to appeal the denial, and can do so with assistance from a San Bernardino workers’ compensation attorney.

Determine the Reason for the Denial

Every workers’ compensation claim denial lawfully must come with an explanation. The insurance provider must state in its denial letter the reason for its decision. You may have received the denial due to horseplay at work contributing to your injuries, for example, or for failing to bring the injury to your employer’s attention by the deadline. Whatever the case may be, the insurance company must explain why it denied your claim. Some reasons are:

  • Missed filing deadline
  • Failed to notify your employer within 30 days
  • Pre-existing injuries
  • Injuries did not occur at work
  • Failed to seek medical care
  • Your employer is disputing the claim
  • Insufficient evidence
  • Reckless or illegal behavior

These are common reasons for workers’ compensation claim denials, but it is not an exhaustive list. If you knowingly caused or contributed to your injuries through any act of negligence, including failing to use safety equipment, failing to perform a duty of your job, or committing an offense, the company may have a valid reason to deny your injury claim. If the insurance company’s reason does not make sense for your case, or if the insurer did not list the reason for the denial at all, file an appeal with help from an attorney.

Hire an Attorney

Consult with a workers’ compensation attorney in California to learn more about why an insurance company may have denied your claim and what you can do about it. An appeals process exists to help you fight back against a denial. Hiring a lawyer can improve your odds of a successful workers’ compensation appeal. A lawyer will have experience handling this legal process and helping clients in your situation. Working with an attorney can make an appeal easier on you, giving you the peace of mind to focus on healing rather than legal legwork.

File an Appeal

With representation from a workers’ compensation attorney, you can file a stronger appeal against the claim denial than you could alone. Your attorney can explain why you disagree with the board’s decision, supported by evidence and documentation of your accident or injuries. You may have new evidence, for example, or evidence that does not align with the reason for the denial. Your lawyer will also make sure you file your appeal by the state’s deadline. The Appeals Board will hear your case and determine whether the denial was an error. The Board will have 60 days from when you filed your petition to come to a decision.

You will need to file a Petition for Reconsideration or Petition for Removal depending on the type of claims denial you received. The first is to appeal a decision made at trial, while the second is for a decision by a judge pre-trial. A three-judge panel will assess each type of appeal. If you lose the appeal, your case may still not be over. Your lawyer can then proceed to file a Writ of Review with the state Court of Appeals. Then, you can go to the California Supreme Court for a further appeal, if necessary. Hire an attorney for assistance with each appeals process after a workers’ compensation claim denial. A lawyer may be able to help you recover fair workers’ compensation.

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