You can reverse the decision if your workers’ compensation claim is denied or rejected by your employer’s insurance company. In California, you can appeal the denial or rejection of your claim by requesting a hearing in front of the local Workers’ Compensation Appeals Board judge. The judge will hear both sides of the case and decide whether the insurance company must accept your workers’ comp claim. Workers’ comp insurance companies will deny claims for numerous reasons. Some insurance companies may routinely deny initial workers’ comp claims in hopes that the injured worker will be discouraged and drop the pursuit of their claim. Other times insurance companies may accept valid claims but deny them later on minor errors on the part of the injured worker.
If your claim has been unfairly denied and you have yet to consult a workers’ comp lawyer, now is the time to contact an attorney. Appealing a claim can be complex, but an experienced attorney knows workers’ comp laws and can guide you through the process. Insurance companies’ interest lies in limiting their payout, not helping you recover from your injury. By working with a skilled California workers’ comp lawyer, you can be confident that there’s someone in the room whose priority is your best interests.
To get an insurance company to reverse their denial, you’ll need to request a hearing before the Workers’ Comp Appeal Board (WCAB). Your dispute with the insurance company is based on whether your claim is “compensable,” referring to whether or not workers’ comp covers your injury and whether the insurance company has liability for the claim. This type of dispute will be addressed in a trial based on “preliminary issues.” To request a hearing before a WCAB judge, you or your lawyer will need to file a Declaration of Readiness (DOR) form to proceed. However, before this form can be filed, you will need to file an application for Adjudication of Claim, which is part of filing your official claim and gives you a workers’ comp case number.
If your claim is denied because the insurance company didn’t believe your injury was caused by a workplace accident or didn’t occur during your working hours, the WCAB judge will set an expedited conference date so that these issues may be addressed quickly and your claim can be either denied or accepted. If the insurance company told you your claim was denied because of these issues, on your Declaration of Readiness to Proceed firm, you’d check the boxes for “Priority Conference” and AOE/COE. AOE means “arising out of employment,” meaning your injury was caused because of your work. COE means “course of employment,” referring to the fact that your injury occurred during your work hours.
A pre-trial conference may be scheduled once you’ve submitted the DOR form. If a pre-trial conference is scheduled, you should receive a notice of the hearing that will tell you the date, time, and location. At the conference, the workers’ comp judge will try and help you resolve the issue over whether or not the claim should be accepted. If the dispute can’t be settled, the judge will set a date for trial. If the judge believes that more information is needed before trial, they will set up a “discovery plan” to find more evidence to support your case. In these instances, the judge may also schedule a status conference to check on the sufficiency of evidence discovered. However, it’s important to note that many disputes over the denial or acceptance of a claim are often settled at the pre-trial conference.
Insurance companies are protecting themselves and trying to limit their payout. Their interests do not line up with those who have been injured during a workplace accident. KCNS Law Group believes in protecting the rights of injured workers and being there for them during difficult times in their lives. Our attorneys know how insurance companies operate and how to build strong claims that they cannot deny. If you’ve been injured at work, you deserve to receive your workers’ comp benefits. At KCNS, we fight for you.