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3 Main Reasons Workers’ Compensation Claims Are Denied in California

  • Published: April 7, 2021

After experiencing an injury at work, there are a variety of concerns that you may have when it comes to obtaining compensation for damages. However, in California, there are certain circumstances in which you may be ineligible to submit claims related to your workplace injury.

If you have recently been hurt for any reason while at your workplace in California, you may be wondering whether or not you will be able to submit a claim for workers’ compensation and receive financial assistance during your recovery process. Your best choice is to contact a trusted lawyer who can help walk you through the legal process for your claim, which can quickly be denied for any of the following reasons.

1. Pre-Existing Injuries

Injuries that occur on a job site can range from something small like a laceration to something much more severe, like a near-fatal and preventable slip-and-fall. Accidents that result in severe damage to an employee should always be taken seriously by an employer, but it can be difficult to obtain compensation for the incident if you have to defend your claim against accusations of pre-existing injuries.

Your employer’s insurance company may state that one of your injuries was pre-existing, such as neck or back pain, and use this as a way to deny you financial coverage. If the company providing workers’ compensation insurance to your employer suspects that you may have experienced one or more of your injuries prior to the accident, they will perform an investigation to determine whether or not this is true.

2. Non-Work Related Injuries

One of the many guidelines for workers’ compensation is that any injury that occurs while performing your job should be eligible for coverage. This includes any accident or harm that an employee may encounter, whether it be a slip-and-fall, a third-degree burn, or the development of carpal tunnel syndrome due to repetitive motion tasks.

However, this rule does not extend to injuries that developed or happened outside of the workplace itself, even if the accident took place while performing a job or task related to your role. This includes any harm sustained while traveling to or from work, while on a scheduled meal break, or during a business trip. As an example, if you get into a car accident on your way to a meeting with a client, your injuries from that collision will not be eligible for workers’ compensation.

3. Employee Intoxication

An insurance company will likely deny any workers’ compensation claim that occurred due to an employee being intoxicated while on the job. In many circumstances, insurance companies will conduct an investigation if they believe there is a possibility that someone was injured at work while under the influence of drugs and/or alcohol, especially if they want to prove that the proximate cause of the accident was the fact that an employee was intoxicated.

This situation may lead to a series of drug testing for the employee who submitted the claim, including blood work and urine analysis. Additionally, the insurance company may conduct interviews with other individuals who witnessed the accident to learn if there were any substances ingested by the victim that could have resulted in impairment and led to their workplace injury.

Contact a Trusted Workers’ Compensation Lawyer in California

Obtaining workers’ compensation in California can be difficult in certain situations, but no one should have to fight an insurance company or employer alone. If you are experiencing roadblocks when attempting to file your claim for damages that occurred while you were at work, reach out to the experienced lawyers at KCNS Law Group. Our team of qualified legal professionals can help you learn more about the process of obtaining compensation and how to know if you qualify.

Don’t go another day without getting a trusted lawyer on your side. Give us a call at (818) 937-9255 or reach out to us online right now to find out more information about how you can schedule your free case consultation.

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