What to Do if Your Workers' Compensation Claim Is Denied

Posted By Law Offices of Wax & Wax || 16-Sep-2019

An unexpected injury can result in high medical bills, a growing credit card balance due to lost wages, and concerns about whether you’ll be able to return to the life you had before. Any harm or illness caused by your job should be covered by workers’ comp—but your insurance may try to find reasons to deny the claim, leaving you to struggle through the expenses on your own. Don’t give up if they reject your initial claim. An experienced lawyer can help you appeal your case and request the compensation you deserve.

Filing an Appeal

If your initial claim is denied, your next step should be to consult with a knowledgeable lawyer (if you don’t have one already) to determine the best route forward. That may depend on why your claim was not accepted. Typical justifications handed out by insurers include:

  • Ineligibility (independent contractors are not covered, nor are some types of incidents)
  • Significant employee misbehavior caused the incident
  • There is proof of injury, or no proof that injury is job-related
  • Employee did not miss work or incur medical bills
  • Administrative or procedural errors
  • Suspicion of fraud

You can fight back against these charges—for instance, by involving witnesses who will testify that you were not breaking rules at the time of the accident or by requesting a second medical and legal opinion. Remember, it’s against the insurer’s financial interests to approve your claim—especially if it’s for an occupational disease or long-term disability that could cost them millions. Don’t let them convince you there’s nothing to be done without hearing from an expert who has your best interests in mind.

Timing Is Everything

If you were denied for administrative errors such as the time gap between the injury and your claim, you should know that the rules are not as strict as they first seem. California law requires employees to report an accident to their employer no more than 30 days after the date of injury and file their case within the next year. However, these deadlines may be flexible depending on your circumstances.

For instance, if the injury or illness doesn’t show up right away, the 30-day deadline doesn’t start until you notice its effects and are able to tie them to your work. Further, the state recognizes that the decision to make a claim may relate to the long-term effects of the injury; therefore, you are allowed one calendar year after your last treatment related to the injury or your last disability payout from your employer or their workers’ comp provider.

Other Roadblocks

One of the most important things to remember in a workers’ compensation case is that records are essential. Having documentation and third-party statements can strengthen an appeal of your workers’ compensation claim. However, there are instances where the dispute extends beyond the injury itself.

Uninsured Employer
Though California requires all employers to provide workers’ compensation, you may not know that your employer is breaking the law until you’re in a bad situation. Thankfully, you do have recourse should you find yourself injured under these circumstances. You can apply for support from the Uninsured Employer’s Benefit Trust Fund (UEBTF) for the compensation you’d normally get from an insurer.

Employer Stonewalling
Even employers who do have the necessary coverage may try to dissuade you from using it because they don’t want their costs to go up. They may “lose” forms, refuse to give you the paperwork they’re required to provide, try to delay the filing process, or make other efforts to stop you from completing your claim. Keep careful records if you think your employer may be doing this and contact a lawyer. Your employer is not allowed to retaliate against workers for filing claims or providing witness statements, but that doesn’t mean they won’t try.

Thinking Beyond the Appeal

If your appeal with the WCAB is denied, you may have other options. Talk to a lawyer to consider if any of the following is right for you:

  • Requesting a hearing with an administrative judge
  • Negotiating directly with the insurance company
  • Taking the insurer to court
  • Filing a lawsuit against third parties: manufacturers of defective products, any parties who intentionally contributed to your injury

If you’ve suffered an injury or illness because of your job, you deserve to be compensated for everything you have gone through. Like everything else, appeals must be filed within a certain time period to be accepted by the state. Don’t let a stingy employer or insurance company deny you fair payment.

Talk to a workers’ comp expert today online or by phone: (818) 946-0608.

Categories: Workers' Compensation
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