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Workers’ Comp Denied: What Can I Do In California?

On Behalf of | Oct 17, 2024 | Workers' Compensation

Getting hurt or developing an illness related to workplace activities is a complex scenario. Unfortunately, no worker in California is exempt from getting hurt.

For example, an injury can result from carrying too much weight, spending too much time sitting or working with hazardous materials.

Most businesses and companies in California have workers’ compensation insurance. This benefit allows injured workers to receive an indemnity covering an injury’s economic and non-economic costs.

The law establishes workers’ compensation as a right of injured workers. However, employers or even insurers may deny a claim.

When this happens, the worker has to face the medical bills alone while trying to recover from his injuries.

Why Was My Workers’ Comp Claim Denied?

The legal process of filing a claim is worth mentioning before describing the main reasons for a denied claim. After an accident at work, the employee must report the injury immediately to the employer. They must submit the appropriate form. Then, they must wait for a response.

At this point, the insurance company can send a letter stating that it has rejected the employee’s claim.

Generally, the insurer’s response letter will contain the reasons for denying a workers’ compensation claim. The most common reasons for denial are:

  • The employer has contested the claim.
  • The employee filed the claim outside the established deadlines.
  • The claim does not contain the proper documentation. For example, medical records are missing.
  • The insurer does not consider the worker’s reported injury to be compensable.
  • The worker’s illness or injury did not result from work.

A denied claim is undoubtedly frustrating. The worker trying to recover from their injuries suddenly faces another obstacle. However, they have certain legal options to fight for compensation.

What Can I Do in California?

After receiving a denied claim, the worker and their attorney may file an appeal with the Workers’ Compensation Appeals Board (WCAB).

This document is intended to show that the worker has followed the process and is entitled to compensation.

The worker must also comply with time and documentation requirements to file the appeal. Therefore, if you have suffered a workplace accident, contact an experienced California workers’ compensation attorney as soon as possible.

The victim of a work injury should seek legal advice from the first moments of his injury. This is done to avoid rejection and to proceed more effectively.