Just about every employee in California is entitled to workers’ compensation benefits if they sustain an on-the-job injury. This type of insurance system is considered “no-fault,” which means that the injured worker is entitled to certain payments regardless of who caused the injury. Unfortunately, it is not uncommon for employers or insurance carriers to treat workers with suspicion or even deny a workers’ compensation claim without a good reason.
When you need a denied workers’ compensation claim attorney, you are in good hands at the law firm of Koszdin, Fields & Sherry. Our attorneys have extensive experience handling these claims, and all of the firm’s partners are board-certified specialists* in this field. We have successfully appealed denied claims for injured workers throughout Southern California.
Give us a call today at our office in Van Nuys to arrange a free consultation with one of our experienced lawyers. We help clients throughout Greater Los Angeles.
California Workers’ Compensation Cases: Insurance Companies Deny Claims When Possible
California has some of the most worker-friendly employment laws in the country. This is particularly true in regard to California’s workers’ compensation laws. With very few exceptions, nearly all employers in our state are required to purchase workers’ compensation insurance. When employees sustain injuries (including mental health injuries) as a result of workplace accidents or workplace conditions, they can file claims for workers’ compensation benefits.
Workers’ comp benefits are meant to compensate injured employees for financial losses they’ve incurred as a result of work-related injuries and health conditions. For example, an injured employee can file a workers’ compensation claim to help cover their medical bills and lost wages.
Unfortunately, insurance companies aren’t always inclined to offer claimants the benefits they deserve in these circumstances. This is due to the fact that workers’ compensation insurance carriers are still technically profit-driven businesses. Thus, if an insurer can avoid financial losses by denying a claim, they may attempt to do so.
Some employers also attempt to have claims denied. An employer might not want a worker to receive the benefits they deserve out of concern that their insurance premiums will go up.
While it’s true that there are instances when employees attempt to take advantage of the workers’ compensation system to secure benefits they aren’t owed, there are also many instances when insurance carriers or employers deny claims that should be paid out.
You don’t need to accept their decision if this happens to you. While hiring a qualified California workers’ compensation attorney to provide you with representation from the start can reduce the odds that your claim will be unfairly denied in the first place, if it has already been denied, review your case with a lawyer for more information about your options. You may be able to successfully appeal this outcome.
How to Guard Against an Unfair Workers’ Compensation Claim Denial in California
If your claim has not yet been denied, but you’re worried this might happen, keep the following tips in mind:
- Promptly seek medical care for work-related injuries and follow all advice of your doctor
- Avoid making any statements to any individuals (even including close family members) in which you might indicate that you caused your own accident as a result of being intoxicated or engaging in horseplay
- Avoid making any statements that might suggest you were off-the-clock when a workplace accident occurred
- Don’t post about your claim on social media
- Don’t engage in any activities (such as sports) that could suggest your injuries are not as severe as you say they are
Additionally, you shouldn’t work directly with an insurance company in these circumstances. An insurance adjuster might monitor your conversations for any statements that could be used to justify denying your claim.
Instead, allow a lawyer to handle all correspondence with the insurance company. Our California workers’ compensation attorneys will ensure you don’t accidentally say anything that an insurance adjuster could cite when explaining why a claim should be denied.
What Reason Are They Giving For Denying Your Claim?
We can advocate for you if (a) your claim was denied outright, (b) you were denied authorization for medical treatment, (c) your benefits or disability rating is not accurate, or (d) your employer is trying to terminate your benefits.
Our knowledgeable denied workers’ compensation attorneys know how to counter the common justifications for denial or termination of workers’ compensation claims:
- The injury was not work-related
- The injury is not serious enough to miss work
- The injury is a pre-existing condition
- The employee did not report the injury to the supervisor
- The employee did not seek medical treatment promptly
- The employee waited too long to file a workers’ comp claim
- The employee is no longer disabled or restricted
- The injury victim did not need any time away from work
- The injury victim was impaired by alcohol or drugs when the incident occurred
- The injury victim was horse-playing when the incident occurred
Our lawyers have successfully appealed all types of injury and illness cases, including repetitive motion injury, toxic exposure, mental stress, and compensable consequence claims.
How Do Workers’ Comp Appeals Work?
If your workers’ compensation claim has been denied in Van Nuys or anywhere throughout the greater Los Angeles area, our attorneys will be ready to help you appeal the denial. There is a specific process involved in these appeals, and you need to make sure that you follow it. Our first step will be to request a hearing with the Workers’ Comp Appeals Board (WCAB).
The WCAB will immediately decide whether or not there needs to be a “priority conference” to expedite the situation or whether they will allow the case to proceed at a regular pace moving forward. At a conference, a workers’ comp appeals judge will attempt to resolve any issues between the injured employee and their employer or the insurance carrier. If the claim cannot be resolved, a judge will order a trial date for the workers’ compensation claim dispute.
We Can Use Our Experience To Appeal Your Rejected Disability Claim
Do not take no for an answer or let the insurance companies take advantage of you. We will intervene directly with the employer or insurer to get satisfaction, and we will represent you in proceedings before the Division of Workers’ Compensation (DWC) and the Workers’ Compensation Appeals Board (WCAB).
For a free consultation with our Van Nuys lawyers for denied workers’ compensation claims, call 818-812-5639 or 800-747-3447 or contact us online. You pay no fees unless we win your case.
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*Certified by The State Bar of California Board of Legal Specialization as specialists in workers’ compensation law
Any person who makes or causes to be made knowingly false or fraudulent material statements or material representation for the purpose of obtaining or denying workers’ compensation benefits or payment is guilty of a felony. Toda aquella persona que sablendo tapa o causa que se produzca cual quier falsas o fraudulentas alegaciones o representación de trabajadores es culpable de un crimen mayor.
