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What to Do if Your Workers’ Compensation Claim Is Denied in California

  • Published: May 12, 2024

When a person is badly injured at work, they incur serious medical costs while losing weeks of wages during the recovery process. Victims of workplace injuries depend on receiving workers’ compensation benefits in order to stay afloat as they heal and recuperate. Unfortunately, many employers and their insurers try to find reasons to deny claims and avoid paying out benefits to victims. For example, employers or their insurers may challenge the victim’s employment status, details surrounding the victim’s injury, or the evidence presented in the victim’s claim.

If your workers’ compensation claim is denied, you can appeal the denial before a workers’ compensation administrative law judge. Victims should work with a team of workers’ compensation attorneys who can help them gather the evidence to present before the judge. Attorneys also understand the correct procedures involved in appealing a claim, and a victims could miss important deadlines if they attempt to represent themselves in an appeal. KCNS Law Group has a dedicated team of workers’ compensation attorneys who want to help victims receive the benefits they need and deserve.

Reasons Why a Workers’ Compensation Claim Could Be Denied

California requires most employers to carry workers’ compensation insurance. Many employers and their insurers try to avoid paying out benefits by attempting to find a reason to challenge a victim’s eligibility. Reasons for denying eligibility for workers’ compensation benefits include, but are not limited to, the following:

  • Employment Status: Your employer or their insurer may argue that you are an independent contractor; therefore, you do not qualify for workers’ compensation benefits.
  • Time of Filing: Your employer or their insurer may argue that you filed your claim too late and missed the statute of limitations.
  • Time of Injury: Your employer or their insurer may argue that your injury did not occur during work hours while you were performing work-related tasks.
  • Cause of Injury: Your employer or their insurer may argue that your injury was caused by your own intoxication or misconduct, not work activity.
  • Lack of Evidence: Your employer or their insurer may argue that your medical records, or lack thereof, do not show enough evidence to support your claim for benefits.

When a victim is legitimately injured while performing work-related activities, workers’ compensation insurance companies should pay the victim the appropriate amount of benefits. Unfortunately, claims adjusters find many reasons to deny victims’ claims for benefits. If your claim was denied, you can appeal your case with the assistance of a team of skilled workers’ compensation attorneys.

What to Do if Your Claim for Workers’ Compensation Benefits Is Denied

When your workers’ compensation benefits claim is denied, you will receive a denial letter from the claims adjuster who reviewed your claim. You can choose to proceed with an appeal, and a workers’ compensation administrative law judge will hear your case. In order to appeal, you must file a case, and you have the option of representing yourself or hiring legal counsel. Most people appealing their workers’ compensation claim denial would greatly benefit from the legal counsel of experienced workers’ compensation attorneys who are familiar with the appeal procedures and can offer guidance on what steps to take.

If you want to increase your chances of a successful appeal, you should prepare to present the strongest argument possible in favor of your eligibility for workers’ compensation benefits. You should identify why your claim was denied in the first place and find the evidence needed to refute that argument. You and your legal counsel will gather all of your relevant medical records, proof of employment, expert medical testimony, and any other evidence that your legal team deems relevant.

Contact the Experienced Workers’ Compensation Attorneys With KCNS Law Group to Discuss Your Claim Today

Victims of workplace injuries heavily rely on workers’ compensation benefits when they cannot return to work. The lost wages on top of lofty medical bills can be overwhelming for anybody, and that is why the timely pay of benefits is crucial. A victim’s eligibility for benefits is determined after the victim submits a claim with their employer. Unfortunately, many employers or their insurers find reasons to deny the payment of benefits to victims. If your claim has been denied, you can still appeal your case before a workers’ compensation administrative law judge. You should not hesitate to contact our team of experienced workers’ compensation attorneys who want to help you receive the maximum amount of benefits you deserve.

At KCNS Law Group, we handle workers’ compensation claims for victims like you. Our skilled attorneys guide victims of workplace injuries throughout the entire claims process, including the appeals process when necessary. You can call (818) 937-9255 or fill out our contact form to schedule your free consultation with us today.

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