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5 Reasons Your Workers’ Compensation Claim Could Be Denied

  • Published: June 12, 2021
5 Reasons Your Workers’ Compensation Claim Could Be Denied (1)

Insurance companies deny workers’ compensation benefits every day. When this happens, you may be left to pay for medical care out of pocket, putting you in a grave financial situation. At the KCNS Law Group, our attorneys provide robust legal representation to those seeking workers’ compensation benefits in California. We will also help you understand why an insurer or employer denied your claim and guide you through the appeals process. 

Your Injury Did Not Happen at Work 

Your injury must have occurred while performing your job duties to be eligible for workers’ compensation benefits. For example, if you work in a restaurant and twist your ankle while taking dishes to a table, you might be eligible for benefits. Conversely, if you were injured on a lunch break or commuting to work, then you might not be entitled to workers’ compensation. 

You Did Not Notify Your Employer 

Accident victims only have 30 days to notify their employer of a work-related injury or illness. When you fail to tell your employer within this time frame, various scenarios might occur. 

  • Firstly, your employer will not be able to conduct an accident investigation, which is vital to your claim’s success. 
  • Secondly, your employer or the insurance company can claim that your injuries did occur at work. They may argue that you would have reported the issue sooner if you were in a work-related accident.
  • Finally, the insurance company may claim that the injury or illness did not happen because of your job. Instead, they may argue that it resulted from a pre-existing condition or something that happened off the clock. 

If you sustained injuries at work, you must report the injury to a manager or supervisor right away. Not doing so can have negative consequences on your workers’ compensation claim. 

An Approved Medical Provider Did Not Treat You 

Depending on where you work and the details regarding your workers’ compensation coverage, you might be required to see select medical providers. Unfortunately, these doctors may try to downplay your injuries. Not only could this be detrimental to your health, but you may also receive fewer workers’ compensation benefits. In addition, seeing an out-of-network or unapproved medical provider for your initial care may invalidate your claim. While you may have to see an approved medical provider, hiring a workers’ compensation attorney can ensure you receive the best medical care possible. 

You Did Not Receive Medical Attention 

While you do not have to see a doctor for every cut and bruise you get at work, you should seek medical care for an injury that requires more than first aid. Remember, you will need medical records to prove you saw a doctor if your injuries warrant it. If you did not receive medical treatment but try to file a workers’ compensation claim, the insurance company may deny it. By seeing a doctor, you can use your medical records to show the nature, cause, and extent of your injuries. 

Delay in Filing Paperwork 

Workers’ compensation providers give strict deadlines, and you must follow them. If you miss a filing deadline, the insurance company will likely deny your claim. Even for injuries that develop slowly over time, such as carpal tunnel syndrome, there are strict time limits. Working with a California workers’ compensation attorney is the most effective way to ensure you file all documents on time. 

Contact a Trusted California Workers’ Compensation Attorney Today 

Understanding why an employer or insurance company denied a workers’ compensation claim could be complex, especially if you are unfamiliar with the legal process. At KCNS Law Group, our workers’ compensation attorneys will ensure that your claim is detailed and accurate and work hard to protect your rights throughout the process. 

Furthermore, our legal team will fight on your behalf, represent you in the appeals process, and gather evidence to build your case. To learn more about how we can help you give us a call at (818) 937-9255 or complete our contact form to schedule a free consultation. 

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