Workers’ compensation is considered a no-fault insurance system. Basically, it is intended to help injured workers get financial compensation for their lost wages and medical expenses if they are injured at work. However, applying for workers’ compensation isn’t always straightforward. Sometimes, a valid claim will be denied. When this happens, you can use a California workers’ compensation lawyer to get the help you need. Through the help of a qualified attorney, you can learn more about your odds of creating a successful appeal.
Why Do Workers’ Compensation Claims Get Denied?
Unfortunately, there are many reasons why a workers’ compensation claim may get turned down. Normally, you will receive a specific reason about the reason when you receive the denial. You can read through the denial letter to learn more about the grounds for the decision and how you can respond. Additionally, you can always reach out to an attorney for advice and assistance.
Workers’ compensation claims can be denied for some of the following reasons.
- There was missing information.
- Medical help wasn’t sought soon enough.
- You had a pre-existing medical condition.
- A file deadline was missed.
- There wasn’t enough evidence of the injury or proof of losses.
- The cause of the injury is disputed.
- There were allegations of intoxication, horseplay, or some other kind of misconduct.
- You didn’t report the injury properly.
- There is a dispute over your employment classification.
A qualified attorney can discuss the reasons why your claim was denied. Then, they can walk you through the best steps for challenging the denial.
How Workers’ Compensation Claims Are Processed, Denied, and Appealed in California
If you have had your workers’ compensation claim denied in California, there are a few important steps you should take. Once you have been injured at work, you must file a claim with the Division of Workers’ Compensation (DWC). There are 24 offices in California that can handle these disputes. To get started, you can use the following steps.
File an Adjudication of Claim With the DWC
The first step is to file your adjudication of claim form. This must be filed at the closest DWC office to your home within one year of when your injury occurred. When you turn it in, you must attach the supporting documents. Because timeliness is important, the best option is to submit this form in person. Your proof of service must also be filed to show that you sent a copy to your employer and the workers’ compensation insurer.
Request a Hearing
After the DWC gets your application, the department will give you a confirmation notice. You will be assigned a case number. At this stage, you can ask for a hearing by turning in a declaration that you are ready to proceed. This declaration must be sent to all of the parties involved. You can also request for a qualified medical evaluator to evaluate you and show that your claim should be covered by workers’ compensation.
Request a Settlement Conference
After your declaration has been filed, you can ask for a mandatory settlement conference. This conference is your opportunity to meet with the insurer’s representative and the DWC judge. Then, the judge will encourage you and the workers’ compensation insurer to settle the case. If you are unable to agree on a settlement, then the case will be sent to trial.
Go Through a Hearing
The DWC hearing will be similar to a civil trial. The employer’s insurer will typically have a lawyer to represent them. You are also allowed legal representation.
During the hearing, both sides will have a chance to present their case to the judge. Unlike jury trials, this hearing will only be decided by a judge. After both sides have finished presenting their arguments, the judge will normally take around 30 to 90 days to make a decision. If the judge decides against you, you can petition the appeals board to reconsider. This must be done within 20 days after the judge issues their decision.
Appeal a Denied Claim
Appealing a denied claim can be complex. The court won’t entertain new evidence during the appeal process. Instead, it will only look for errors in the case record. If the judge has made an error, the decision can be overturned.
Get Professional Help with Your Workers’ Compensation Claim
If your claim for workers’ compensation has been denied, bills can quickly start to pile up. By working with a professional attorney, you can get help reviewing your case and deciding on the right course of action. From remembering important deadlines to reviewing evidence, workers’ compensation claims can be challenging to manage. An experienced lawyer can help you achieve the best results possible.
