Here’s Why Your Workers’ Compensation Claim Might Get Denied (And What To Do If It Happens)

BY: Koszdin | Saturday, June 16, 2018.

If you have been injured on the job or suffer from a work-related injury or illness, you are entitled to workers’ compensation benefits. For you and your attorney, that is plain and simple. For others, on the other hand, not so much.

We asked our Los Angeles workers compensation attorney from the Koszdin, Fields & Sherry law firm to outline the most common reasons why your workers’ comp claim might get denied by your employer’s insurance company.

Spoiler alert: if it does get denied, do not give up. You may still be able to recover your compensation (more about it below).

Reasons why your workers’ comp claim might get denied

While there are many invalid and illegal ways an insurance company can deny your workers’ comp claim in Lancaster or elsewhere in California, here are several lawful reasons behind claim denials:

  • There is insufficient evidence of your injury or illness.
  • Your injury or illness is not job-related.
  • Your injury occurred due to another job or factors unrelated to work.
  • You do not require medical treatment, or your injury is not severe enough to be eligible for workers’ comp benefits.
  • You can return to work even though you were diagnosed with a work-related injury or illness.
  • You missed the deadline. In California, the statute of limitations for filing a workers’ comp claim is one year from the date of your job-related injury or illness.

Your injury or medical condition does not meet state guidelines. There are several restrictions the state of California has imposed on workers’ compensation claims for certain types of injury, illness, or medical condition. Speak to an experienced workers’ compensation attorney in Lancaster or elsewhere in California to find out more.

You filed a workers’ comp claim AFTER you were fired, laid off, or quit. Unless you had a good reason for the delay, or you were fired in retaliation for reporting an on-the-job injury, your employer’s insurance company’s denial of your claim may be lawful if it was filed after your employment was terminated, you were laid off or decided to quit.

Other legal challenges of obtaining workers’ comp benefits in California

More often than not, injured employees in Lancaster and all across California struggle with proving that their injury is work-related. Most employers in the state, in an attempt to avoid paying workers’ comp benefits, will argue that (a) you were not performing your job duties at the time of the injury, (b) you were involved in some type of misconduct at the time of the workplace accident, (c) work or workplace conditions were not the predominant cause (over 51 percent) of your injury or illness.

Whatever the insurer’s reasoning for the denial of your workers’ compensation claim, you should seek legal advice from a Lancaster workers’ compensation attorney in order to appeal the denial and collect more evidence proving the nature and severity of your injury as well as establishing that your injury or illness is job-related.

If you do not know what to do after your workers’ comp claim is denied, consult with some of the best workers’ compensation lawyers in California at the Koszdin, Fields & Sherry law firm. Some claims get denied by accident, and in other cases, you may not hear back from your employer’s insurance company within 90 days after filing the claim. Whatever the case, contact our law firm and schedule a free consultation. We can help you obtain the workers’ comp benefits you truly deserve. Call at 818-812-5639 or 800-747-3447 or fill out this contact form today.

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