Reasons why your Workers Comp claim is Denied
- Missing the deadline to report the injury
In California, the deadline to report a work injury is typically 30 days from the injury date, with some exceptions. Reporting early establishes a clear timeline for proving the injury’s work-related nature, crucial if symptoms develop later. Missing the deadline can make filing a workers’ comp claim tougher. Prompt reporting ensures timely processing and benefits receipt. If you have a valid reason for missing the deadline, like being unconscious, an extension may apply. Immediate injury reporting is essential for a smooth workers’ compensation process.
- Injury isn’t a work-related injury
In most cases, a workers’ comp claim will be denied if the injury isn’t work-related. If your injury is not work-related, it typically falls outside the scope of workers’ compensation coverage. In such cases, you would need to pursue other avenues, such as private health insurance or a personal injury lawsuit, depending on your injury’s circumstances. For example, injuries that occur while you are working on a personal project or errand. For example, if you are injured while running an errand for your employer but are not working at the time or during work hours, your injury may not be considered work-related.
In such cases, the injury might not get workers’ compensation benefits since your employer may not be liable for your injuries. Still, you can benefit from your insurance company or any other government scheme. It is advisable to speak to an experienced denied workers compensation claim attorney.
- The injury has arisen from a Pre-Existing Condition
While workers’ compensation typically covers workplace injuries, sometimes injuries at work can worsen pre-existing conditions. If a prior injury or medical condition flares up due to a work-related incident not directly tied to job duties, it might not be seen as a separate workplace injury but rather as an exacerbation. In this case, the pre-existing condition is considered the “root cause,” and the work incident is the “contributing factor.” Workers may still be eligible for compensation, but benefits could be adjusted based on the pre-existing condition’s role. The exact benefit reduction varies by circumstance, emphasizing the need to consult a denied workers’ compensation claim attorney for individual cases.
What to do when your workers’ comp claim is denied
If your workers’ comp claim in California is denied, you have the right to appeal the decision. The first step is to file a Petition for Reconsideration with the Workers’ Compensation Appeals Board (WCAB) within 20 days of the date of the denial. The petition should include a detailed explanation of why you believe your claim should be approved and any supporting evidence.
If the WCAB denies your Petition for Reconsideration, you may file a Petition for Writ of Review with the California Court of Appeal. The writ of review requests the court to review the WCAB’s decision. The court will only grant a writ of review if it finds that the WCAB’s decision was erroneous or arbitrary.
If the court denies your Petition for Writ of Review, you may then appeal the decision to the California Supreme Court. The California Supreme Court will only hear appeals in workers’ compensation cases if they involve a significant legal issue.
Conclusion
The appeals process can take several months or even years. It is important to note that the time limits for filing an appeal are very strict. If you miss the deadline, you may lose your right to appeal. You should consult with a denied workers compensation claim attorney as soon as possible if your workers’ comp claim is denied. A denied workers compensation claim attorney can help you understand the law and your rights, and they can file the necessary paperwork to appeal the decision. By choosing us to represent you, you’re selecting a dedicated legal partner who will work tirelessly to help you appeal a denied claim, gather the necessary evidence, and represent your interests before the workers’ compensation board. We understand that your financial stability and well-being may depend on a successful claim, and we are here to fight for your rights. If you or someone you’re acquainted with is confronting white-collar crime charges in California, reach out to us now at (844) 414-1768.
