Your Workers’ Compensation Claim Was Denied: Now What?

Workplace accidents are a common occurrence, affecting a significant portion of the workforce throughout their careers. One of the ways they can be compensated for the damage is through workers’ compensation claims. These compensation benefits are specific to each injury and they range from medical bills to 50 percent of wage replacement.

The negative side of workers’ compensation benefits is the tendency to have your claim denied. This situation can be shocking for victims of workplace accidents. The good thing is, if your claim is genuine, you can turn your denial into approval. But what can you do when you face situations like this?

What You Should Do When Your Workers’ Compensation Claim is Denied

Here are practical steps to consider if your workers’ compensation claim is denied:

Review the Reason or Reasons Your Claim was Denied

Your first step is to check the stated reasons your claim was denied. Once you know their reasons, you can contact your attorney or hire one. Here are some major reasons for your claim to be denied:

• Late Application

In California, if you are injured at work, you must report the injury to your employer within 30 days. If you do not, your compensation benefits can be denied by referring to the late application.

• Dubious Injury

This means that you can only lay claim on the injury you sustained at your workplace at that particular time. You cannot lay claim on injuries you have in the past. Why? Your workplace did not have anything to do with your previous injury. In addition, if your case was investigated and it was detected that your current injury was a result of the previous ones, your claim might get denied.

• Illness Beyond Scope

According to Californian laws, some occupational illnesses cannot qualify for workers’ compensation benefits. Therefore, if your situation is beyond the scope set by your state, your claim might be denied.

Contact an Attorney

Before you take any step against the reasons your claim was denied, first contact your lawyer, and if you do not have one yet, hire one. Ensure you hire an attorney who has adequate knowledge and experience in workers’ compensation statutes. They can help you understand your rights, assess the weaknesses and strengths of your case, and guide you through the entire process.

In addition, once you have found a suitable attorney, get your relevant documents ready, such as pay stubs, witness statements, employment records, medical records, and denial letters.

Appeal

When a workers’ compensation claim in California is rejected, a letter detailing the precise grounds for the denial will be sent by state representatives. This will be very helpful to your lawyer and yourself when you are developing an appeal plan since you will want to make sure that you cover every aspect of the denial letter.

Next, you will have to appear before an administrative court to submit your case, which is part of the appeal procedure. At this hearing, you may also offer any pertinent evidence.

You are eligible for benefits if the court finds that the evidence you provide supports your claim. “You do have the option to appeal at a higher level if the judge determines that there is insufficient evidence to support your eligibility for compensation benefits,” says attorney Scott Silberman of Silberman & Lam LLP.

Conclusion

You can find a workers’ compensation attorney in any law office in California, and they can provide guidance tailored to your case. They can also help you contact your insurance company if need be, which helps overturn your claim denial.