Many injured workers are denied medical benefits, which makes it too difficult to recover and get back on the job. Denial of medical treatment is very common in Los Angeles. If you have been injured on the job, you may be entitled to receive medical care for your injuries through your employer’s workers compensation insurance. While workers’ comp is supposed to provide benefits for most workers, these benefits are funded by insurance companies, which means they have the authority either to approve or deny your claim.
Why are these claims denied?
In order to be eligible for these benefits, you will have to comply with some specific deadlines. In California, you have up to 30 days to report your injury. Also, you must file your workers’ comp claim within one year if the insurance company hasn’t provided any benefits, and up to five years if they provided some of the benefits. Unfortunately, many insurance companies become suspicious when the claim is filed too long after the alleged accident occurred and they may think the claimant is lying. In order to avoid confusion or your claim being denied, it is best you file your claim in a timely manner and hire an experienced Los Angeles Medical Benefits Attorney to protect your interests.
Off-site and pre-existing injuries
Claims are sometimes denied because the employer believes that the injuries didn’t happen at work or if you had a preexisting condition. To qualify for medical benefits, workers must be injured while working. If you were injured while off the time clock, you may not qualify for medical benefits. Also, if you are injured while commuting, unless you were conducting work-related business, your claim may also be denied.
The same rule applies to pre-existing injuries. If you have a condition due to a previous accident and the condition is made worse due to a recent accident at work, the insurance company may claim that your injuries were caused by your pre-existing condition and they will try to minimize your benefits.
Minor injuries
Some injuries are not serious enough to require medical intervention or time off from work. If you take too long to file your claim, the insurance company may feel your injuries aren’t that severe. This is why it is important you get treatment for your injuries as soon as possible. You are entitled to receive medical benefits only while you are recovering from work-related injuries.
The importance of hiring a Los Angeles medical benefits attorney
Because workers’ compensation insurance companies are profit-centric businesses that are not inclined to lose money when doing so can be avoided, injured workers seeking medical benefits must be careful to avoid making any mistakes that could jeopardize their chances of recovering what they may be owed. You could prevent yourself from securing the compensation you need to cover the cost of your medical treatment if you miss deadlines, ignore a doctor’s orders, or even make certain paperwork errors when submitting a claim.
This is not meant to worry you. It is meant to encourage you to coordinate with a reputable Los Angeles medical benefits law firm in these circumstances. The following are a few ways our team might help you:
Investigating your accident
California’s workers’ compensation laws are based on the no-fault system. This means a claimant does not need to show that their accident resulted from someone else’s negligence. They can theoretically recover medical benefits through a workers’ compensation claim as long as they were operating in the scope of their employment when they were injured.
Again, though, in an attempt to justify denying your claim, an insurance carrier might suggest that your accident occurred when you were not actually working for your employer.
The fact that an insurer is presenting this argument does not mean it’s rooted in fact. That said, to demonstrate that an insurer is wrong and you are in fact eligible to recover medical benefits, you need to present evidence showing that your accident truly did occur while you are on the job. A Los Angeles medical benefits lawyer can help you do so by investigating the accident and gathering evidence supporting your case.
Documenting your medical treatment expenses
The process of coordinating with doctors and gathering all documentation necessary to show that you deserve a certain amount of compensation when seeking medical benefits can be tedious and confusing if you don’t have experience with these matters.
Don’t burden yourself with this task at a time when your priorities should involve getting rest and recovering. Although a lawyer may need some minor assistance on your end to facilitate collecting documentation of medical expenses, in general, our LA medical benefits attorneys can gather and present this type of documentation on their own.
Offering general guidance
An insurance company might investigate your claim with the goal of finding reasons to either deny it entirely or offer less money than you may expect to recover. While your claim is being investigated, you must avoid errors (such as not following a doctor’s advice or engaging in physical activities that would exacerbate your injuries) that can give an insurer leverage.
This is another reason to work with a Los Angeles medical benefits attorney. Our experts will gladly answer any questions you may have and offer general advice regarding what you should and should not do while your case is still being resolved.
What to do if your claim is denied
It is common for insurers to deny claims in order to maximize profit. If you believe your claim was wrongly denied, it is important you hire a Los Angeles Medical Benefits Attorney immediately and file within the time limits required in California. For more information about your potential case and to help you determine whether you are entitled to receive medical benefits and disability benefits for your injuries, contact us today and schedule your initial case assessment with one of our Medical Benefits Attorneys in Los Angeles.
