Employers are required to carry workers’ compensation insurance to protect employees and employers alike. While the idea of providing compensation for on-the-job injuries is simple, the process often becomes complex in practice.
In the majority of cases, the insurance company denies the initial claim filed by the worker. The insurance company benefits from denying a claim because they don’t have to pay. When the injured employee is unaware of their rights, they may give up hope on getting compensation. An experienced San Diego workers comp lawyer can help you appeal a denied workers’ comp claim and get the benefits you deserve.
Understanding Workers Compensation: What It Is and How It Works
As local work comp lawyers we can tell you that accidents can happen at any work site. If you were involved in an accident, you could file a workers’ compensation claim to receive financial assistance. Unfortunately, you may find your workers comp claim denied shortly after filing it. Before we get to why they may have denied your claim, let’s first discuss what workers compensation is.
Workers compensation is a type of insurance plan that allows employees to receive benefits after receiving injuries on the job. The benefits provided by workers compensation should cover an employee’s medical expenses. The coverage may offer additional benefits depending on the severity of the claimant’s injuries.
Workers compensation may also cover some of the psychological injuries an employee has sustained due to their line of work.
How Do I File for Workers Compensation?
Your first course of action after getting injured during a workplace accident should involve seeing a doctor. Employees need evidence to substantiate their claims, and doctors can provide that. Have your doctor confirm that you received injuries from your recent accident.
Once you have received the necessary medical documents from your doctor, you can file your workers comp claim. This would also be a good time to hire a workers compensation lawyer. After hiring a workers comp lawyer, they can file your claim with your employer’s insurer. They will tell you which documents you need to fill out and gather them for you.
At this point, you will now wait for the decision on your claim. If your claim is approved, you will receive your compensation not long after. However, you have more work to do if they deny your claim. Enlisting the help of a workers compensation attorney is recommended if you want your claim to be successful the first time around.
What Do I Do if My Workers Comp Claim Was Denied in California?
Did your employer’s insurer deny your compensation claim? An insurer may deny your claim if they believe that a workers compensation plan should not cover it. They may also cite certain technicalities to deny you coverage. Frustrating as that denial may be, it should not deter you from seeking compensation. There are still things you can do to obtain the compensation you rightfully deserve, and we have detailed them below.
- Hire a Workers Compensation Lawyer: Your fight for compensation got more complicated. To make it easier to manage, you should hire a WC lawyer.
- File an Application for Adjudication of Claim: Next, you need to obtain an Application for Adjudication of Claim. The Application for Adjudication of Claim is the form you need to formally open a case with the Workers Compensation Appeals Board. Consult with a lawyer to ensure you properly fill out the Application for Adjudication of Claim. You must fill it out for the Division of Workers Compensation office that covers your county.
- Wait for the Notification That Your Case Has Been Filed: You will now need to wait for the DWC office to confirm they have received your claim. They will send you a notice to confirm the filing and include your case number. Hang on to the statement and all the documents related to your claim.
- Request a Hearing: With your claim officially filed, you can now request a hearing. To do that, you and your work injury lawyer must file a Declaration of Readiness to Proceed.
After filing the declaration, they can set a date for your mandatory settlement conference. The mandatory settlement conference is the hearing you requested.
- Attend the Mandatory Settlement Conference: During the mandatory settlement conference, you, the opposing party, and the judge will discuss the case. The goal of this conference is to settle. If you do not reach a settlement, the judge will set a date for a trial.
- Make Your Case at the Trial: Once the trial begins, you and the opposing party can argue your respective cases in front of the new presiding judge. The judge will hear both sides and render a decision. Notably, you may have to wait thirty to ninety days for the judge’s decision.
- Continue Your Appeals: If you still believe that the judge made the wrong decision in denying your compensation claim, you can move forward with additional appeals. Start by filing a Petition for Reconsideration. If that petition fails, you can then file a Writ of Review. Exhaust your options until you get the right decision in your case.
Reasons Commonly Given for Denied Claims
- Failing to Report Your Accident on Time – Each state has laws that pertain to the amount of time you have to report your injuries to your employer. Failing to meet the time requirements will result in claim denial.
- You Didn’t Produce Witnesses – One of the first things experts advise an injured employee to do after an at-work accident is to identify witnesses. If you didn’t require emergency care or there were no witnesses on the accident scene, the insurance company may say that the accident didn’t happen or that it isn’t the cause of your injuries.
- You Didn’t Seek Appropriate Medical Care – You need to get medical care for any work-related injury immediately after your accident. In addition, it is important to follow through with all of the recommended treatments and tests ordered by your physician. Failing to get medical care makes it more difficult to prove that your injury is as serious as you claimed.
- Pre-existing Conditions – The insurance company may claim that your injury didn’t occur from the accident if you have previous health conditions or injuries impacting the same area. Careful and thorough medical records can help prove that the injuries are work-related. Even if the accident further aggravated a pre-existing injury, you have the right to workers’ comp benefits to cover the additional cost of treatment.
- You Were Using Alcohol or Drugs When the Accident Occurred – If a blood test shows that you were under the influence of any mind-altering substance during the accident, the insurance company will deny your claim.
Do I Need a Workers Compensation Lawyer?
Do claimants need to partner with a San Diego denied workers compensation lawyer, or can they proceed without their legal guidance? Claimants can pass on hiring a lawyer, but they would also miss out on the services and benefits they provide.
Your Attorney Can Guide You through the Process
If this is your first time filing a workers compensation claim, it will be easy to make mistakes. Unfortunately, those mistakes could prove costly as they could delay the arrival of your compensation or prevent you from receiving any payout altogether. Avoid those pitfalls of the filing process by working with a WC lawyer.
Your Attorney Can Help You Meet Deadlines
In California, workers have thirty days to report their injuries to their employers. Meanwhile, the deadline for filing a workers comp claim ranges from one to three years. It is easy to miss those deadlines, especially if you were badly hurt during the accident. Hire a work comp attorney to ensure you do not miss your deadlines.
Your Lawyer Can Help Settle Disputes
You should also consider hiring a San Diego denied workers compensation claim attorney if you have disputes with your employer or their insurer. A good lawyer’s assistance will be invaluable as you go through the appeals process. Do you feel that you are receiving inadequate compensation? Your lawyer can also bring that up in court and demand additional compensation from the insurer.
A lawyer can also draw attention to a doctor who is mishandling your situation. They can discuss the mistakes made by the doctor and hold them accountable.
Top Local Workers Comp Lawyers in San Diego
If your workers’ compensation claim is denied, contact The House of Workers’ Compensation for a free consultation. We specialize in handling workers’ comp claims and helping our clients get the compensation they deserve. Hire an experienced workers’ comp attorney to represent your claim properly.
Some of the locations our San Diego workers comp lawyers serve include: Chula Vista, Oceanside, Carlsbad, Coronado, Escondido, El Cajon, Poway, Del Mar, Encinitas, San Marcos, La Mesa, Vista, National City, Julian, Santee, Imperial Beach, Lemon Grove, Spring Valley, Solana Beach, Fallbrook, Bonita, Lakeside and more.