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How to Handle the Denial of Your Workers’ Compensation Claim

How to Handle the Denial of Your Workers’ Compensation Claim

How to Handle the Denial of Your Workers’ Compensation Claim

Whether you injured yourself at work or suffer from prolonged exposure to toxic chemicals, you deserve just compensation in the form of workers’ comp benefits. Although most claims go through without a hitch, the fact remains that some workers’ compensation claims come back denied.

Getting a workers’ compensation claim approved starts by understanding the potential issues that can derail a claim. If your workers’ comp claim came back denied, you need to know how to handle the denial to ensure you receive financial benefits.

Why Some Workers’ Compensation Claims Come Back Denied

Employers and their insurance companies do not want to pay higher premiums because of an increase in the number of workers’ comp claims filed by employees. This means one of the common reasons for denied claims is because employers fight to prevent an increase in insurance premiums.

Here are a few other common reasons for denied workers’ compensation claims.

Failed to Meet Deadlines

Workers’ compensation laws include a statute of limitations for filing a claim. If you fail to meet the deadline for filing a claim, expect the State of California to deny your workers’ compensation claim. You might not get penalized for missing the injury reporting deadline, but you will get penalized for missing the claim filing deadline.

Injury Was Not Work-Related

The biggest point of contention many employers have with workers’ compensation insurance is whether an illness or an injury is work-related. This can be an especially difficult thing to determine for professionals that work in the delivery industry, such as driving for Uber. To qualify for workers’ compensation, an injury must have happened in the workplace.

Your Medical Condition Does Not Qualify for State Guidelines

State law can place restrictions on certain types of medical conditions when it comes to eligibility for workers’ compensation. Many of the medical conditions that are not eligible for financial assistance include psychological and cumulative trauma conditions.

Handling a Denied workers’ Compensation Claim

Do not surrender your legal right to receive workers’ compensation benefits just because the state denied your claim. The letter that informs you about a denied claim should include an explanation. Although the issue might be a mistake made on one or more documents, the chances are good that either you missed the deadline for filing a claim or your employer has disputed the validity of your claim. Whatever the reason for a denied workers’ compensation claim, you have to act quickly to receive just compensation for your injuries.

File an Appeal

The denial letter that you received from the state should include information about how to file an appeal. First, you file the proper paperwork for your appeal and then you attend a hearing in front of an administrative law judge. You need to submit additional medical evidence that strengthens your case, as well as have witnesses testify to support your claim. The administrative hearing can be held with an administrative law judge from the state labor department or the state board of workers’ compensation.

Work with an Employment Attorney

Unless you can clear up a misunderstanding that occurred because of missing and/or incorrect paperwork, you should contact a California employment lawyer on the day you received your claim denial letter. An employment attorney will help you file an appeal that is more persuasive than your original workers’ compensation claim. Your lawyer can also ensure you meet every deadline mandated by the state during the appeal process.

Schedule a free case evaluation with the experienced employment attorneys at the PLBSH Law Firm by calling (800) 435-7542.

Certified Workers'
Compensation Specialist
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