Workers' Compensation Denials
Was Your Claim Denied? We Can Help!
If you were recently injured on the job, you may have filed a workers’ compensation claim and expected a favorable outcome. Unfortunately, just because you filed a claim does not necessarily mean it will be accepted. The Division of Workers’ Compensation (DWC) in California can deny your claim for a variety of reasons. The good news? You have the right to appeal their decision.
Before you make an appeal, however, it is helpful to know why your claim was denied. At Pacific Workers', The Lawyers for Injured Workers, we carefully assess each case and create an informed strategy based on our findings. Rather than blindly moving forward, our clients can count on calculated efforts every step of the way.
Fill out a free case evaluation form to tell our Oakland workers’ compensation attorneys more about your case!
Common Reasons for Claim Denials
A claim denial indicates that the claims administrator did not believe your work injury should be covered by workers’ compensation. You will be alerted of the denial by letter, at which point you have the opportunity to challenge the decision.
A claim can be denied for any number of reasons, including:
- Failure to report or file the claim on time
- The employer disputes the claim
- Injuries are not severe enough to warrant a claim
- Injuries were caused by stress, not work-related conditions
If you want to object to the denial of your claim, you must file both an Application for Adjudication of Claim and a Declaration of Readiness to Proceed. These documents indicate that you want your case heard by a judge. After a hearing and a trial, a decision is made about your case.
CAN YOU GET WORKERS' COMP IF YOU ARE AN INDEPENDENT CONTACTOR?
According to California labor laws, independent contractors are not eligible for Workers' Compensation through their employer, and are, in fact, responsible for their own Workers' Compensation insurance. However, that doesn't mean that you can't receive Workers' Compensation if you are an independent contractor. While that might seem like a contradiction, there's actually a very simple explanation: many people who are classified as independent contractors are really employees.
Misclassification is a common problem, rampant in industries like trucking. Countless businesses in the state and around the country misclassify part-time, or even full-time, employees as contractors in order to save money on benefits, social security, Workers' Compensation insurance, and payroll taxes. This is illegal, and there are penalties from the labor board and from civil court. Employees who have been misclassified as independent contractors are eligible for Workers' Compensation benefits, and are entitled to treatment when they get hurt.
Workers' Compensation cases involving misclassification are more complicated than average. There must be a trial at the Workers' Compensation Board to prove that the injured worker is really an employee.
There are many factors that go into proving employment status, the most crucial of which are:
- Does the employer provide the equipment necessary to do the job?
- Does the employer set the workers' schedule and tell them when & where to work?
If the answer to both of those questions is, "yes," you're most likely an employee, regardless of what kind of tax form you filled out, and an experienced Workers' Compensation attorney can easily prove the truth and get you the benefits that you deserve. However, there are some sectors in which labor law is still catching up with technology. For an example, the classification of Uber drivers is currently a gray area being worked out in the courts. But in most cases, the law is clear: injured workers who have been misclassified as independent contractors can receive Workers' Compensation.
Retain an Oakland Workers’ Compensation Lawyer
Before the appeals process, you have the right to obtain legal representation. We cannot emphasize enough how important this is – the attorney you choose can have an immense impact on the outcome of your case. Our firm is here to give you the best possible chance at a favorable decision and with 130+ years of experience, you can feel confident when we’re on your side.
Don’t wait! Your claim is bound by time constraints and should be handled proactively. Get in touch with Pacific Workers’ Compensation Law Center today. Offices in Oakland and Concord!
We have Helped OVER 8,000 CLIENTS aND WE CAN HELP YOU TOO!
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Thank you for being so kind and completely sympathetic to my case!
“I started my fight against my company's workers comp and after talking to Almarie for the first time I already felt a lot of weight off my shoulders. It feels nice to have someone fighting for your rights but also keeping you in check for your own good.”
Jazzie D. Daly City, CA -
They took care of me!
“Bilal worked on my case and he was very professional, friendly, and kind to me. I was so nervous about my deposition and he made me feel very comfortable and less stressed about the whole situation.”
Gabi O. Sacramento, CA -
The most down to earth team I have ever met!
“They have strong communication and I was respected throughout the whole process. They had never given up on me!”
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I'm forever grateful & thankful to all!
“I especially want to thank Mr. Jason Insdorf, who worked in attaining a settlement I never expected.”
L.S. Union City, CA
Workers' Comp FAQ
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Am I Eligible for Workers’ Compensation?
In California, all employees are eligible for workers’ compensation with very few exceptions. If you are classified as an “employee” (rather than an “independent contractor”), you are eligible to receive benefits. This is true regardless of how many employees your employer has, how many hours you work, how much you make, whether you work part-time or full-time, or whether you are a seasonal worker. Additionally, undocumented workers are also eligible for workers’ compensation granted they meet all other eligibility requirements. In contrast, independent contractors and certain other workers, including some volunteers, household workers who are employed by a family member, and others, are not able to file for workers’ compensation benefits.
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Can't I Just File for Workers' Compensation on My Own?
Filing for workers' compensation on your own increases the chances that your claim will be denied. One small misstep can prevent you from obtaining the compensation you need for your injuries. In addition, the process is usually complex and tedious, especially for someone with no workers' compensation law experience. It is extremely advantageous that you seek reliable and experienced legal guidance for your claim.
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What Can I Expect from the Workers' Compensation Process?
As soon as you reach out to us for help, we will assign you a full-time case manager and attorney. An application will be filed with the Workers' Compensation Appeals Board (WCAB) on your behalf. We will get started on your case immediately to help you receive the medical care you need. If we are unable to receive a fair settlement from the insurance company, we are ready and willing to take your case to trial. After a few months, you will most likely give a deposition. One of our highly experienced attorneys will prepare you and stand at your side the entire time. You don't even have to attend court hearings! One of our trained hearing officers or attorneys can attend on your behalf.
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Can My Employer Tell Me to Use Sick Time or Vacation/Personal Time off (PTO) If I’m Injured at Work?
Following a work-related injury, you may not receive workers’ compensation benefits right away or your workers’ compensation claim may be denied. You may receive a note from your doctor that you may take time off work due to your injuries, but how will you be paid if you are not actively seeking workers’ compensation benefits? Your employer may tell you to use your state-mandated/employer-provided sick time in order to continue being paid while you are out of work. Once this sick time is exhausted, your employer may tell you that the only way you can continue to be paid is if you use your vacation or PTO time. In some cases, this may actually be the only way to continue receiving wages while you are out of work and not receiving workers’ compensation benefits. For more information, check out our video with Attorney Bilal Kassem on this topic by visiting our Facebook page!
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Can I Get Workers’ Compensation If I Was Fired?
If you were terminated while already receiving workers’ compensation benefits, this does not necessarily affect your right to receive benefits. However, if you were terminated “for cause” (for example, if you were fired because you were caught stealing from your employer), you will not be able to continue collecting benefits. If you were not fired for cause, but were laid off due to your position being terminated or various other reasons, you may still be able to continue collecting your workers’ compensation benefits. If you believe you were terminated because you filed for workers’ compensation or because you were hurt at work, you may have grounds for a retaliation claim. Learn more, including whether you can continue receiving workers’ compensation benefits if you were laid off due to the coronavirus pandemic, see our video with Attorney Bilal Kassem on our Facebook page.
