Filing a claim after you are disabled, debilitated, or otherwise unable to work due to a workplace injury is really only the beginning of your workers’ compensation claim. If there is a missing signature from just one bit of paperwork, or if the claims administrator is not convinced that your case justifies workers’ compensation benefits, your claim could be denied. Will you know what to do then?
Contact our Orange County workers’ comp attorneys if your claim has been denied.
What to Do If Your Claim is Denied
If your claim is denied, you must first be aware that it was not the decision of your boss or employer. Instead, it is the decision of a claims administrator working for or with an insurance company. Due to the disconnection between yourself and the people handling your claim, simply asking for a second review of your paperwork for potential errors will likely be fruitless.
To get to the source of the problem, you will likely need to file for an appeal, administrative review, and a mandatory settlement conference (MSC). During the MSC, you will meet with your claims administrator and attempt to reach an amicable settlement. It is highly recommended that you work closely with a professional attorney at this time so you do not accept lowballed amounts. If your MSC is unsuccessful and you were not given the chance to receive fair compensation, your case will go to an administrative review, which is considered a form of trial in California; again, the presence of a workers’ compensation lawyer will be incredibly useful.
- During your administrative review or trial, you will be able to:
- Make arguments as to why you require workers’ compensation
- Present evidence for your case
- Refute claims presented by the claims administrator
The verdict or ruling for your trial will not be issued immediately. You will have to wait anywhere between 30 to 90 days for a written decision to be mailed to you. A petition for reconsideration can be filed if the decision is not in your favor, and a final, similar process begins.
Looking for Help? Contact Our Team
So many workers’ compensation claims are initially denied for the smallest errors or invalid reasons. The real tragedy is not that they are denied but that workers who need the help accept the denial without resistance.