Santa Rosa Workers' Compensation Denial Attorney

Has Your Workers' Compensation Claim Been Denied?

Workers in Santa Rosa face numerous risks on the job every day. Whether you're a construction worker laboring under the sun, a nurse attending to patients in a hospital, or an office employee spending long hours at a desk, workplace injuries can happen unexpectedly, leaving you in physical pain and financial distress. In such times, the workers' compensation system is designed to provide crucial support to employees injured on the job.

However, the sad reality is that many legitimate workers' compensation claims are unfairly denied by insurance companies. When you're dealing with a denied claim, the world can seem unjust and overwhelming. That's where Pacific Workers', The Lawyers for Injured Workers, comes to your rescue. Our expert team is here to help you navigate the complex process of workers' compensation claims and particularly, the stressful situation of claim denials.

Call (888) 740-6434 or contact us online today to schedule a free consultation.

Why Was My Claim Denied?

A workers' compensation claim denial occurs when an employer's workers' compensation insurance company refuses to provide benefits to an injured worker. In California, as in many other states, workers' compensation is a system designed to provide medical benefits and wage replacement to employees who are injured or become ill due to work-related activities. However, there are various reasons why a claim may be denied.

Common reasons for workers' compensation claim denials in California include:

• Failure to Report in a Timely Manner: In California, an injured worker is typically required to report the injury to their employer within 30 days. Failure to do so can lead to a denial of the claim.
• Missed Filing Deadlines: There are strict deadlines for filing a workers' compensation claim in California. If the injured worker or their employer fails to meet these deadlines, the claim may be denied.
• Disputed Injury: Sometimes, the insurance company may dispute whether the injury is work-related. If it's unclear whether the injury occurred on the job, the claim may be denied until further investigation is conducted.
• Preexisting Condition: If the insurance company believes that the injury is the result of a preexisting condition or a non-work-related event, they may deny the claim.
• Lack of Medical Evidence: Proper medical documentation is crucial for a workers' compensation claim. If there is insufficient medical evidence to support the claim, it may be denied.
• Injury Not Severe Enough: In some cases, the insurance company may argue that the injury is not severe enough to warrant workers' compensation benefits. There are specific criteria for what qualifies as a compensable injury.
• Intoxication or Drug Use: If the employee was under the influence of drugs or alcohol at the time of the injury, this can be grounds for a claim denial.
• Fraud: If the insurance company suspects that the claimant is attempting to defraud the system, they may deny the claim.
• Failure to Cooperate: If the injured worker fails to cooperate with the claims process, such as refusing to provide necessary information or attend medical evaluations, the claim may be denied.
• Excluded Activities: Some activities that occur while on the job may not be covered under workers' compensation, such as injuries sustained during recreational activities or acts of violence that were not work-related.

You Can Appeal a Denial

Once the insurance company denies your claim, you can file an appeal. The most effective way to appeal your denial is by having a lawyer on your side in many situations. A denial often comes following a small miscue in the initial paperwork.

A lawyer can help you file the necessary paperwork timely and effectively. An attorney helps confirm accuracy in the paperwork to limit the insurance company’s chances to deny your claim a second time. When you file an appeal, make sure you have someone on your side who can strengthen the position of your claim.

What Can I Do If My Claim Is Denied?

If your workers' compensation claim is denied, it can be a stressful and challenging situation to navigate. However, you do have options to address the denial and seek the benefits you rightfully deserve.

Here are the steps you can take if your workers' comp claim is denied:

1. Review the Denial Letter: Start by carefully reviewing the denial letter you receive from the workers' compensation insurance company. This letter should explain the reasons for the denial and outline the process for appealing the decision.
2. Contact Your Employer: Reach out to your employer or supervisor to discuss the denial. Sometimes, misunderstandings or errors in the paperwork can be resolved at this stage.
3. Consult an Attorney: It's advisable to consult with an experienced workers' compensation attorney, especially if your claim has been denied. They can provide legal advice and guide you through the appeals process. Many attorneys offer free initial consultations.
4. File an Appeal: In California, you have a limited time to file an appeal after your claim is denied. The specific deadlines can vary, so consult with your attorney to ensure you meet them. To initiate the appeal, you typically need to complete the appropriate forms, which your attorney can help you with.
5. Gather Additional Evidence: Your attorney will work with you to gather any additional evidence needed to support your claim. This may include medical records, witness statements, or expert opinions to demonstrate that your injury is work-related.
6. Attend a Hearing: In California, denied workers' compensation claims often go through a hearing process with the Workers' Compensation Appeals Board (WCAB). Your attorney will represent you at the hearing, presenting your case and arguing for the benefits you deserve.
7. Negotiate a Settlement: Prior to or during the hearing process, your attorney may negotiate with the insurance company for a settlement. This can result in a lump sum payment or ongoing benefits, depending on your case's circumstances.
8. Explore Alternative Dispute Resolution: In some cases, mediation or arbitration can be used as alternative dispute resolution methods to reach a resolution without going to a formal hearing. Your attorney can advise you on whether this is a suitable option for your case.
9. Follow Medical Treatment Plans: Continue following your prescribed medical treatment plans and attending all necessary medical appointments. This helps establish the ongoing need for benefits.
10. Keep Records: Maintain records of all communication related to your claim, including emails, letters, and notes from conversations with your employer, the insurance company, and your attorney.
11. Stay Informed: Stay informed about your rights and responsibilities throughout the process. Your attorney will provide guidance, but it's essential to be an active participant in your case.
12. Stay Patient and Persistent: The workers' compensation appeals process can be lengthy, but persistence can pay off. Trust your attorney's expertise and be prepared for a potentially protracted legal battle.

Remember that each workers' compensation case is unique, and the steps you take may vary depending on the specific circumstances of your denial. Consulting with an experienced workers' compensation attorney, like those at Pacific Workers', The Lawyers for Injured Workers, can significantly improve your chances of a successful appeal and obtaining the benefits you deserve.

If you've received a denial on your workers' compensation claim and need legal advice or assistance with an appeal, don't hesitate to contact us at Pacific Workers' for a free consultation.