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What to Do if Your Workers’ Compensation Benefits Claim is Denied

man looking concerned at letter in the mail

When workers’ comp claims are denied, an employer’s insurance company benefits because they get to avoid paying out benefits to the injured worker. Most of the time, they will use every means necessary to deny claims, and injured workers are the ones who suffer.

If your workers’ compensation claim was denied in California, there are some steps you and your workers’ comp attorney can take to reverse that decision.

Common Reasons for Denied Claims

There are two types of claim denials. The insurance company may deny the entire claim or part of the claim. In the latter case, they could deny a part of your claim and a particular disability benefit.

Claims are denied for several reasons. Many denials are based on the insurance company’s dispute of legal evidence, factual evidence, or insurance coverage. Some examples include:

  • Employment. The insurance company may claim that you were not an actual employee of the company or that you were an independent contractor.

  • Coverage. The insurance company may deny that they provided workers’ compensation coverage at the time that your work injury occurred.

  • Scope of employment. Your claim may be denied if they claim that your injury was not work-related. In order words, you were not performing a work-related duty when the injury occurred.

  • Lack of evidence. They may claim that they received no information indicating that your injury occurred at work. You may have failed to report the injury or your employer may have failed to take the proper steps to report it.

  • Medical information. They may claim that your injury occurred naturally at work and that it was not caused, aggravated, or accelerated by work-related duties.

Fighting a Denial of Your Workers’ Comp Claim

As we discussed, many insurance companies will deny valid claims in order to spare the cost of paying benefits. Denials can be fought by scheduling a hearing with the Worker’s Comp Appeals Board (WCAB).

You and your workers’ comp attorney will need to file a Declaration of Readiness to Proceed (DOR) and gather all the necessary evidence to prepare for a pre-conference trial and possible trial thereafter. Many disputes are resolved at the pre-conference trial with the help of the presiding judge.

If your workers’ comp claim was denied in California, you need legal representation immediately. There are time limits for fighting denials that you can’t afford to miss. The workers’ compensation attorneys at The Law Offices of Larry S. Buckley are here to gather all the evidence needed to present in front of the judge. This way, you have the best chances of receiving maximum disability benefits for your work injury.

Contact our firm at (530) 413-0245 to schedule your free case review.

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