If you were injured on the job in California, it is possible that your workers compensation claim will be denied. The denied claim can either be a decision of your employee or the claim can be denied by insurance. The reason for denial can be attributed to any number of reasons which might include: You didn’t report your injury right away or at all; You were using alcohol or drugs at the time of your accident; You had a pre-existing condition, such as heart disease or diabetes; Your employer’s insurance company has not paid out a lot of claims, and they are being more careful with their payments. According to California law, injured workers who have applied for state-funded workers’ compensation benefits and are denied may pursue other avenues to obtain them. This includes suing the employer in civil court or appealing the decision with a public agency.
Further, if you feel like your employer is not paying out the full benefits to which you are entitled under California law, and then you need to hurry in order to protect your rights and interests. You need to make sure that the insurance company has enough information about the accident or illness that caused your disability so they can conduct a thorough investigation into what happened and develop fair compensation.
Workers’ Compensation denied! Now what?
It’s best to have a workers compensation attorney or denied insurance claim lawyer to handle your claim from start to finish to avoid mistakes and make the claim as strong as possible.
If you have already been denied benefits, you still have the right to appeal and many benefits are available through the appeal process. If your employer’s insurance company has denied your employees’ claims for compensation or has not approved all of the payouts you think they deserve, you have the right to challenge that decision by filing a “compensation claim“. If the injured worker or their attorney suspects that the dismissal of the claim was unfounded, you may file an appeal with the California Workers’ Compensation Appeals Board (WCAB) to request an appeal hearing. At a hearing (which is like an informal trial), the judge can hear both sides of the case and decide whether the insurance company should accept your workers’ compensation claim.
Injured workers may receive a denial letter from their employer or workers’ compensation insurance company if liability for claims is denied. A claim is considered refundable if the employer or its insurance company does not accept or reject it within 90 days. Therefore, employers’ compensation insurers have 90 days to accept or deny liability for claims within 90 days of the injured worker returning the form.
In addition, after the application is submitted, the employer must give permission for the treatment of injuries caused by an industrial accident. This processing limit will remain in effect until the request is accepted or denied, up to a maximum of $10,000. Most injuries and illnesses received by employees meet this standard, but there may be some circumstances in which employees dismiss a complaint.
When you receive a notice that your claim has been denied, it means that the claims administrator does not consider Workers’ Compensation to cover your injury. At this point, you will be able to challenge this denial with the California Workers’ Compensation Division or DWC.
If you want to object to the rejection of your request, you must file a claim with one of the 24 offices located throughout the state. If you want a judge to hear your case, you must apply for a decision on your claim in the county where you live or the county where you were injured. The loan application must be submitted within one year from the date of the accident. In order for your compensation claim to be filed promptly within one year of the date of injury, rather than simply submitting it to the DWC District Office for filing, it is recommended that you submit your application and supporting documents to the DWC District Office and obtain certified copies of the submitted documents, so you can prove when you filed them.
You have up to one year from the date of your injury to file a DWC-1 claim form. You have only 20 days from the date you receive the denial letter to appeal the decision.
Depending on the specifics of your case and the reasons why insurance companies denied your claim, this will likely result in litigation before a civil judge with a binding and final determination of your reimbursement. After you file a motion to review your denial of workers’ compensation in San Diego, the California Workers’ Compensation Board of Appeal will make a decision.
To ensure your appeal in the Los Angeles area is successful, please contact a work injury attorney as soon as your application is denied. By working with an experienced attorney on your appeal, you can expect the process to be performed as accurately and efficiently as possible in preparation for your second approval.
You can also reach us at – GSantiago@DYSLawgroup.com