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Denied Workers’ Compensation Claims

California law guarantees workers the right to insurance coverage after an on-the-job injury.  If you were hurt at the office, on a construction worksite, while driving a company vehicle, or due to exposure to a hazardous substance, you have the right to compensation for your medical expenses and lost wages.  You are covered by your employer’s workers’ compensation insurance policy, even if your workplace injury was your fault.  If you were injured on the job and your workers’ compensation claim was denied, you have the right to know why.  Moreover, you have the power to fight back against the denial.

An Arcadia workers’ compensation attorney at the Law Offices of Dulio R. Chavez II has years of experience getting coverage for Californians injured while on the job.  We will not let employers or workers’ compensation insurance providers wrongfully deny your claims.  If you were hurt on the job, you are not alone.  We will fight for your rights.

Why are Workers’ Comp Claims Denied?

Workers’ compensation claims are not always accepted by insurance providers or employers.  To qualify for workers’ compensation, an injury or illness must have occurred while at work or while performing work-related duties.  Here are a few of the most common reasons employers and insurers put forth in denying workers’ compensation claims:

  • The injury occurred outside of the workplace and outside of the worker’s occupational duties. If a worker got into a car accident while driving their personal vehicle on the weekend or their lunch break, for example, then they might not be covered by workers’ compensation.
  • The worker waited too long to report an injury and file their claim. California workers must report an illness or injury to their employer within 30 days to qualify for coverage.  Injured workers typically have a year to file a claim if the insurance company did not pay out any benefits.  Missing these deadlines might mean missing out on workers’ compensation coverage.
  • The injury or condition does not qualify for workers’ compensation coverage. Injuries must meet a minimum threshold of “severity” to be eligible for coverage.  For example, if a worker did not receive any medical treatment after an injury or work-related illness, then they might not be eligible to receive benefits.
  • The injury was a “pre existing condition” and thus not work-related. Proving that an injury or illness did occur at work is typically the heart of any workers’ compensation case.

Just because an insurance provider cites one of these reasons for denial does not mean that you cannot still qualify for workers’ compensation coverage.  Not all denials are proper, and not all are made in good faith.  Insurers are looking for any reason not to pay out benefits and are often overzealous with their denials.  A dedicated California workers’ compensation attorney can help you contest a denial.

How to Contest a Denied Claim

If your workers’ compensation claim was denied or rejected by your employer’s workers’ compensation insurance provider, there are steps you can take to contest that decision.   Californians have the right to appeal a denial and request a hearing before a local Workers’ Compensation Appeals Board judge.  You or your workers’ compensation attorney will file an Application for Adjudication of Claim.  After denial, you or your attorney will file a Declaration of Readiness to Proceed form.

The judge will then schedule one or more conferences and hearings.  Ultimately, if the claim cannot be settled, the judge will hold a sort of mini-trial, at which the judge will hear arguments from either side and make a decision.

Trusted Advice and Representation for Workers’ Compensation Claims in Pasadena and Southern California

For talented, dedicated, and compassionate help with a workers’ compensation claim in Southern California, contact the Arcadia Law Offices of Dulio R. Chavez II for a free consultation at 626-357-3303.

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