Workplace injuries are compensated by workers’ comp. It covers medical, lost earnings, and rehab. Workers’ compensation claims aren’t always accepted initially. Know your options if your San Francisco denied workers compensation claim. Appealing a claim denial is hard, but completing the steps can increase your chances of winning compensation.
Understand The Reason for Denied Workers Compensation Claim
You must discover the reasons for Denied Workers Compensation Claim. Knowing the refusal claim denial reasons can help you resolve the issue or overturn the judgment. Denied Workers Compensation Claim often include:
- The insurance company may claim that your injury is not as severe as you stated or that there is insufficient medical documentation related to the workplace accident.
- Workplace injuries must be reported to your employer within 30 days in California. The injury may have been claim denied for late reporting.
- A pre-existing condition disagreement could deny your claim if the insurer believes your damage was medical rather than work-related.
- Employers or insurers may argue that your injury occurred at work, especially for repetitive stress injuries or incidents outside of work hours.
- Denied Workers Compensation Claims include deadlines and forms. Form errors or late deadlines might deny benefits.
- Carefully read the insurance claim denial letter to understand the rejection. If the letter is unclear, contact the denied workers compensation claims adjuster. Knowing the denial reason will help you move forward.
Review Your Denial Letter and Insurance Documentation
Study the refusal letter to understand why the denied workers compensation claim was denied and how to appeal. Insurance companies must explain claim denials for decision-making.
Gather the following documentation after the refusal notice:
- Workers’ compensation lawsuits rely largely on medical documents. Maintain records of your injury and work impact. Doctor’s notes, treatment plans, test results, and expert opinions.
- Employee accident reports should document workplace injuries. Written report of injury causes.
- Employee emails, letters, and other information can establish your injury was reported quickly. Supporting your claim requires documentation.
- If someone witnessed your injury, their testimony can support your claim. Witnesses can describe the accident and injuries.
- Complete documentation will strengthen your position and advance you.
File a Petition for Reconsideration (If Applicable)
If your workers comp denied, appeal to the insurer. If the insurer miscalculated your case, you can file a California Petition for Reconsideration. Petitions are formal requests to the WCAB to reconsider denials. Once the petition is filed, the WCAB will consider the facts to determine if the denial was warranted or if further review is needed. Accepting the petition may need a reconsideration or new hearing when both sides present their cases.
Seek Assistance from a Workers’ Compensation Lawyer
Workers’ compensation can be complicated, especially if denied. For help after a refusal, contact a professional workers’ compensation attorney. An attorney can explain and appeal the denial. A denied workers compensation claim lawyer can assist in the following ways:
- An attorney will review your case to find claim defects that may have caused the denial. We’ll verify paperwork flaws and omissions.
- Your attorneys may use medical specialists, accident investigators, and other resources to gather evidence.
- Workers’ compensation lawyers perform well in hearings. They will handle legal arguments and cross-examination to speed things up.
- An attorney ensures a fair reimbursement for your injury and entitlements. Your chances of victory increase with a claims denied attorney.
Consider Independent Medical Examinations (IME)
Your insurance company may order an IME to assess your injury. Insurance companies frequently hire IME doctors, whose opinions can affect claim clearance. Insurance sector payments to doctors make IMEs biased. Dispute the IME results or think the doctor misrepresented your injury? Request an Independent Medical Evaluation (IME) by a doctor of your choosing. A second opinion can validate your work-related injuries and improve your diagnosis. If the second opinion varies from the IME’s, you can dispute the denial at the WCAB or settlement negotiations.
Explore Alternative Dispute Resolution (ADR)
ADR may settle California workers’ comp cases. Mediation or settlement negotiations help you and the insurance company reach a deal without a lengthy court trial. WCAB hearings are slower, more expensive, and more formal than ADR. A trained mediator can help you and the insurance company settle without a trial. ADR may work if you’re open to settlement negotiations, and a lawyer can help you secure a fair offer.
File a Lawsuit (In Certain Cases)
Only workers’ compensation is normally available for job-related injuries, but personal injury lawsuits are possible. Beyond workers’ compensation, you may be able to sue a third party for employer negligence, such as a defective product, equipment failure, or car accident. Personal injury cases allow you to pursue non-economic damages like pain and suffering, mental distress, and others that workers’ compensation does not. Consult a California workers comp attorney about this option.
Conclusion
San Francisco workers’ compensation claims can be refused, but there are methods to appeal and fight for your benefits. Understanding why your workers comp denied, getting the right proof, and engaging a workers comp claim denied lawyer will help. You must act quickly and wisely to get the compensation you need to recover and move forward after your accident, whether you petition for reconsideration, request a hearing, or negotiate a settlement. At The Law Office of Spiro K. Pistiolas, we represent the best workers’ comp attorney California who have handled a wide range of workers comp denied cases. Get in touch with us today at (844) 414-1768!
