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Arcadia Workers Compensation and Medical Benefits Attorney

In California, workers who are injured on the job are entitled to workers’ compensation benefits provided by their employer.  All employers are required to provide workers’ comp insurance coverage for employees, even if they only have one employee.  So long as your injury happened on the job, or your injury or illness happened as a result of you performing your job duties, you are entitled to coverage.

Workers’ comp guarantees you compensation for medical costs incurred as a result of your workplace injury.  Medical treatments are, of course, expensive.  Workers’ comp insurers often look for any reason they can find to minimize or deny a claim and avoid paying for costly treatments and healthcare.  The Arcadia medical benefits attorneys at the Law Offices of Dulio R. Chavez, II have decades of experience helping California workers like you get the medical care you need after a workplace injury.

Why Are Medical Benefits Denied?

Workers comp insurers are required to cover medical treatments for covered injuries.  There are a few reasons why employers and workers’ comp insurance providers may try to deny a claim.  The workers’ comp insurer may have actual cause to deny your claim, they may be mistaken, or they may be trying to stretch the facts or the policy language in order to find a reason to deny your claims or get you to accept a lower settlement amount.

Some of the reasons claimed by workers’ comp providers to deny claims include:

  • You did not suffer a serious injury, or you don’t need medical treatment generally
  • The medical treatment you are seeking is not medically necessary
  • Your injury happened outside of the workplace and outside the scope of your employment
  • The medical treatment you are seeking is unrelated to your workplace injury
  • You took too long to file your claim
  • Your injury or illness predated your employment
  • You have provided insufficient medical evidence to back up your claim
  • The workers’ comp attorneys have hired investigators to watch you and have decided that you are not actually injured, or you don’t actually need time off of work

Workers’ comp insurance providers are required to explain in writing why they denied your claim.  With the help of a seasoned Arcadia workers’ comp attorney, you can challenge their denial.  You can negotiate with the insurance provider to revitalize your claim and, for example, provide the additional evidence they claim was missing.  If they still refuse to pay your claim, you and your workers’ comp attorney can request a hearing before the state workers’ compensation board.

Supporting Your Medical Benefits Claim

Probably the most common reason workers’ comp insurers use to deny claims is a lack of medical evidence.  They will claim that your injury or proposed treatment (or the treatment you already received) lacks sufficient medical evidence.  To support your claim, you and your attorney may need to gather additional documentary evidence demonstrating that you are seriously injured, unable to work, and your proposed course of treatment is medically necessary for the injuries you suffered.

Additional evidence could include, for example:

  • Collecting your medical records
  • Obtaining medical opinions from your treating physicians and other recommended doctors
  • Obtaining an independent medical examination from a physician designated by your employer or workers’ comp insurance provider
  • Appearing at a deposition to answer questions about your injury or treatment
  • Conducting a deposition of medical experts and your physicians
  • Gathering testimony from a vocational expert about your job requirements
  • Statements from your family and friends about your limitations and daily capabilities

Your California medical benefits attorney can help you put together the evidence you need to ensure that you get medical treatment without going bankrupt.  Your workers’ comp lawyer will help you build a strong claim for coverage, understand the reasons for a claim denial, gather the evidence necessary to support your claim, and negotiate with your workers’ comp insurance provider to obtain a settlement that covers all of your costs and provides you the benefits that you deserve.

Help Getting the Treatment You Need After an Arcadia Work Injury or Work Accident

If you’ve suffered a serious workplace injury in California, the seasoned and effective Southern California medical benefits lawyers at the Law Offices of Dulio R. Chavez II and Associates are here to provide advice and representation.  Let us help you demand the benefits you’re owed.  Call our Arcadia workers’ comp legal office for a free consultation at 626-357-3303.

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