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.
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
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.
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.