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What Can You Do if Your Workers Compensation Claim Is Denied

If your workers’ compensation claim is denied, you can do several things, including:

  • Finding out the reason for the denial
  • Filing an appeal if the denial cannot be easily fixed any other way
  • Hiring a workers’ compensation attorney if you have not already done so

Why Was My Workers’ Compensation Claim Denied?

Sometimes a claim is denied for a very basic reason that can quickly be resolved through a discussion with your employer or the claims adjuster. For example, maybe:

  • They misread some information on your claim and (based on that misunderstanding) believe you didn’t follow proper procedure when filing
  • They misplaced some of the paperwork you submitted
  • You made an error on the paperwork, but there could still be time to fix it and resubmit

In other cases, your employer or their insurer could have more serious concerns, such as whether:

  • Your injury is actually work-related (if it isn’t, they are under no obligation to pay you workers’ compensation benefits)
  • You have accurately calculated the type or amount of benefits you qualify for
  • You have submitted enough evidence to prove that you were injured on the job

You may have to file an appeal if your workers compensation claim was denied for one of these more complex reasons.

How Can I Appeal a Workers’ Compensation Claim Denial?

According to the California Department of Industrial Relations (DIR), you can appeal your case by filling out the proper forms and filing your case with the Division of Workers’ Compensation (DWC) office that serves your area.

Once you have filed a claim, you can expect to:

  • Receive confirmation from the DWC that they received your appeal
  • Request a hearing with an administrative law judge (ALJ) who can consider your case
  • Work with the ALJ and the insurer’s representatives to try to settle your case without a hearing
  • Attend a trial and plead your case if negotiations aren’t successful
  • Wait for the judge to send you their decision after the trial
  • Ask for reconsideration if you disagree with the judge’s decision

The DIR also points out that you can hire a workers’ compensation lawyer to assist you with your claim. The claims and appeals process can take quite some time and an attorney can walk you through every step.

Why Must I Negotiate Before a Trial?

Settlement negotiations are mandatory for everyone who wishes to proceed with an appeal. The DWC wants to give both parties one last chance to smooth out their differences without going through the time-consuming process of a trial. Faced with the prospect of fighting a lengthy battle, the insurer could be more open to offering what you need. However, every case is different. A workers compensation attorney Los Angeles can help you prepare for any eventuality.

Should I Hire a Workers’ Compensation Attorney? 

Whether you hire an attorney is up to you. However, it is important to remember that seeking benefits can be very complicated, and even a single innocent mistake could delay or derail your claim.

You can hire a lawyer to help you even before your workers’ compensation claim is denied. They could prevent your claim from being denied on a technicality by carefully reviewing all of your paperwork before submitting it. They also have the legal knowledge to deal with serious denials more efficiently.

In addition, your lawyer could:

  • Explain more about how the claims process works and what you can do if your workers’ compensation claim is denied
  • Collect enough evidence to establish a connection between your injury and your workplace accident
  • Calculate the monetary value of your injuries so you get all of the benefits you deserve
  • Represent you at hearings and at trial so you don’t have to appear yourself
  • Evaluate any offers your employer’s insurer makes and prevent you from settling for less than you need

Many lawyers offer free case reviews to prospective clients. This is a good opportunity to learn more about your rights and the benefits of hiring a lawyer without risk or obligation.

What Can I Get from Workers’ Compensation?

In California, workers’ compensation benefits cover many different kinds of losses, both physical and financial. Per the DIR, you could potentially receive:

  • Treatment for your work-related injury
  • Disability, either temporary or permanent
  • Vocational training to help you qualify for a new position (if you are unable to return to work for your old employer)

If you’re seeking workers’ compensation on behalf of a loved one who passed away from a work-related injury, you could qualify for death benefits.

Workers’ comp benefits are designed to help hard-working Californians recover from injuries and get back on their feet. Unfortunately, receiving those benefits isn’t always as simple as filling out a form. Sometimes you must fight for fair compensation. A Los Angeles personal injury attorney can help.

Can I Prevent a Claim Denial?

In some cases, no. Sometimes the insurer or the employer genuinely believes that a person doesn’t qualify for benefits, and the only way you can get benefits is by going through the proper legal channels.

That said, there are things you can do to reduce the chances of running into trouble with your claim, including:

  • Consulting a workers’ compensation lawyer—they know the ins and outs of the system and can help you navigate it
  • Including plenty of evidence to support your claim, including medical records and financial documents
  • Having your lawyer fill out all necessary paperwork so you don’t accidentally miss a deadline, use the wrong form, or log incomplete or inaccurate information

Struggling to Get Workers’ Compensation? Reach Out Today

At KJT Law Group, we understand you need workers’ compensation benefits as soon as possible. If your claim is denied, you can rely on our firm to fight hard for a better outcome. Call (818) 507-8525 or contact us online to schedule your free case evaluation.

We Will Fight For You

Contact our firm to get started.
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