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What Can I Do if My Workers' Comp Claim is Denied?

If you were injured at your place of work, such injuries are generally covered by your employer’s workers’ compensation insurance. Unfortunately, these claims are sometimes denied, but that does not mean you are all out of options. You might be able to appeal the denial through your state’s board of workers’ compensation.

Why Was My Claim Denied?

Before moving forward with an appeal, it is important to understand why your workers’ compensation claim might have been denied. Some of the most common reasons for claim denials include:

  • You failed to report the injury in time: After sustaining an injury at work, you must report it to your supervisor as soon as possible, usually within a few days.
  • Your claim was not filed in time: Once again, it is critical to be aware of deadlines. Generally, injured workers have about 30 to 90 days to file an initial claim.
  • Your employer disputes your claim: In some cases, an employer might dispute the claim. For example, he or she might say that the accident occurred outside of work, was caused by horseplay, or involved some other disqualifying set of circumstances.
  • The injury you sustained is not compensable: If your claim is a stress-related injury, these are often difficult to prove and might be the reason for your denial.
  • You did not seek medical treatment: To receive workers’ compensation benefits, it is typically required for one to have sought medical treatment.
  • There is not enough evidence that the injury was related to work: Sometimes it is not entirely clear whether or not an injury happened at work, which can result in a denial of your claim.

Appealing a Denial of Your Workers’ Comp Claim

To begin the process of appealing your denial, you will need to request a hearing before the Workers’ Comp Appeals Board (WCAB). To request this hearing, your attorney will need to file both an Application for Adjudication of Claim and a Declaration of Readiness to Proceed (DOR) form. Following this step, you should receive a notice of hearing that will tell you the date, time, and the location of the conference. The workers’ comp judge will attempt to help you resolve the issues regarding your claim during this conference and, if it cannot be settled, he or she will set the matter for trial. If more information is necessary, the judge might also set up a discovery plan to gather evidence.

In most cases, disputes over workers’ comp claims are settled during the pre-trial conference.

Orange County Workers’ Compensation Attorneys

Employers in California are required to carry workers’ compensation insurance and must pay benefits to injured employees. If your workers’ compensation claim was denied, you do not have to settle for this outcome. The Orange County workers’ compensation team at Alvandi Law Group, P.C. will guide you through the process of appeals to ensure you receive your benefits.

In order to make this experience easier for you and your family, we do not accept payment until we win your case.

Contact our firm today at (800) 980-6905 to request your free case evaluation.