Although a work related accident is bad enough, having your workers’ compensation claim denied is terrible. For injured employees, California’s workers’ compensation program pays medical bills, missed income, and other expenses. Insurance claim denied are common, though, and knowing how to manage one can make all the difference between living in poverty and being reimbursed. Should your insurance claim denied, keep trying. This thorough guide can help you appeal your denied claim and provide ideas to raise your prospects.
Why Was My Insurance Claim Denied?
Following steps depend on knowing why your insurance claim denied. For various reasons, California insurers could reject workers’ compensation claims:
- Sometimes, a lack of medical costs and documentation results in a rejection of denied claims. Should the insurance company reject your claim without evidence of a work-related injury,
- Should your workplace injuries result from a pre-existing condition or if you exhibit similar symptoms, the insurance could declare it unrelated to employment.
- Should you not contact your company within thirty days, your claim can be denied. California law calls for quick reporting in order to get workers’ compensation benefits.
- Should the insurance determine your injury was not work-related, they could support your claim. This is usual even during business hours when an injury results from outside of the workplace.
- Should you not seek medical attention or address your injuries within a reasonable period, your claim could be refused.
- Workers’ compensation claims have somewhat strict timeframes. Insurance claim denied can follow from missing deadlines, such as completing the claim form one year following an injury.
Understanding the specific reason for the denied workers compensation will help you prepare a stronger appeal.
- Review Your Denial Letter: Read the refusal letter from your employer’s workers compensation insurance provider before appealing a denied workers comp claims. This letter should detail the insurance claim denied. If the reason is unknown, ask the firm or insurance agent for an explanation.
- Compile more data: Knowing the rejection, look for further data to strengthen your case. Ask your doctor for supplementary records should your denied claims for inadequate medical evidence. These records should clearly show the degree of your injury and how your employment brought about it.
- Formal Appeal: California’s Workers’ Compensation Appeals Board (WCAB) can review an insurance claim denied. Understanding the procedures will enable you to negotiate the challenging appeal system.
- Think about calling a denied workers compensation claim attorney: Particularly if you are still recovering from an accident, you could find the workers’ compensation appeals process taxing. Having a seasoned workers’ compensation attorney increases your likelihood of success.
- Think about alternative conflict settlement: Settlement agreements or mediation can help workers with compensation problems. ADR lets you settle outside of court should you and the insurer be unable to agree in court. A neutral third party steps in to assist in a resolution for the parties. Over a judges’ hearing, this can save money and time.
- Be tenacious and patient: Workers’ comp appeals could span months or years. Keep cool and get in touch with your attorney or WCAB all through the procedure. Sort and record correspondence and case papers. Should you be refused workers’ compensation, keep going. With careful planning, strong evidence, and expert legal counsel, you can appeal the ruling and get paid.
Conclusion
Although it is annoying, a workers’ compensation insurance claim denied is not hopeless. Appealing the denied workers’ compensation claim denial and winning your case will depend on following the procedures above, gathering strong proof, and consulting professional legal advice. Recall that you could fight for advantages to keep your funds intact and aid in your healing from an ailment. Should you be denied workers’ comp, act immediately. You deserve your rights protected and your workers comp claim denied. At the Law Office of Spiro K Pistiolas, we represent the best workers comp attorneys who have handled a wide range of cases. Get in touch with us today at (844) 414-1768!
