The workers’ compensation is supposed to help you, not hurt you, following a work-related accident. Your work injuries or a work illness should be paid for by the workers’ compensation system. It might help you with wage replacement, medical care, and many other benefits you are owed. But what can you do if your workers’ comp claim was denied? Denials are more common than you think, but the right attorney can help you seek the compensation you are owed.
At Ratto Law Firm, P.C., our California workers’ compensation attorneys know how to help. We help you determine why you faced a denial, or help prevent one in the first place. We understand the appeals process and how to guide you through the workers’ comp system.
Why Did My Workers Compensation Claim Get Denied?
Employers, or the insurance company representing them, might deny your claim for several reasons. Some of the most frequent include:
- Disputes About Whether the Injury is Work-Related: The employer may try to claim that you got injured outside of work, whether than in your duties.
- Late Reporting of the Injury: Workers must notify their employer within 30 days of the injury, or they risk losing their right to file a claim.
- Insufficient Medical Evidence: If medical records do not clearly link your injury to your job, the insurer may deny benefits.
- Pre-Existing Conditions: Claims may be denied if the insurer believes your injury stems from a prior health issue rather than workplace activities.
- Failure to Follow Procedures: Missing deadlines, incomplete forms, or not attending required medical evaluations can result in denial.
What Should I Do After a Workers’ Compensation Denial?
Just because your claim is denied doesn’t mean there is nothing you can do. Knowing why it was denied can help you create a plan of attack with your attorney for how to overturn that decision.
- Review the Denial Letter Carefully: The letter you get should tell you why your claim is denied. Read their reasoning and see what options you might have to fix it.
- Gather Supporting Documentation: Collect medical records, witness statements, and any evidence that connects your injury to your job duties.
- Consult with a Workers’ Compensation Attorney: Working through the workers’ compensation system isn’t easy. A dedicated lawyer knows how and effectively guides you through it all.
The Appeals Process
In California, the appeals process is handled through the Workers’ Compensation Appeals Board (WCAB). The process generally follows these steps:
- File an Application for Adjudication of Claim: This begins the process and starts your case.
- Request a Hearing: Known as a “mandatory settlement conference,” this requested hearing is where both sides can present evidence about your claim.
- Present Evidence: Your attorney will help you present evidence about your injuries and claim. This would include medical documents, testimony by experts, and other documents.
- Judge’s Decision: If the case gets to the judge, they will ultimately give a ruling. If you don’t agree with their decision, you can petition for reconsideration or file an appeal.
How an Attorney Can Help With Your California Workers’ Compensation Case
While you are allowed to represent yourself, it isn’t advisable. This process is complicated and small errors could mean your claim gets denied. Attorneys can help you by:
- Meeting all deadlines
- Complying with all procedural requirements
- Gather evidence to support your claim
- Interview witnesses and do depositions
- Negotiate settlements
- Help you collect lost wages and medical care costs you are owed
Get Help with a Workers’ Comp Denial in California
Even though workers’ comp denials are common, it does not mean there is no hope. They are not the end of your case because your attorney can help you appeal and take other actions to pursue the monetary compensation to which you are entitled. Pursue your claim with a knowledgeable lawyer today.
Our team at Ratto Law Firm, P.C. provides you with the advice and representation you need. Contact us today for a consultation.