If you have a work-related injury or illness in the manufacturing industry and submit a claim, there is a chance that you will be denied benefits. One misstep and you could become ineligible for valuable benefits like free medical treatment and partial wage replacement. However, there is a workers’ compensation appeals process that allows you to push back on this rejected claim.
When appealing this decision, you can submit your appeal online or in person as the appropriate Division of Workers’ Compensation’s (DWC) district office. Workers’ compensation lawyers can help you if your manufacturing industry claim was denied, so act quickly. Continue reading the blog below for reasons for denied workers’ comp claims and steps for handling workers’ comp appeals in the manufacturing industry.
What Happens If a Claims Administrator Denies Your Workers’ Comp Claim for a Manufacturing Industry Work-Related Injury or Illness?
Según el DWC, a claims administrator can deny an injured worker’s initial claim if they think workers’ compensation does not cover their illness or injury. This decision might be for a substantive reason, such as the injury not being work-related, or a procedural reason, like you did not file your claim for benefits in time.
If you disagree with this decision, you can contest the denial with an appeal. You will have to follow strict rules if you want to challenge the denial of your application for workers’ comp benefits.
DIR allows you to work on your manufacturing industry appeal with an attorney or represent yourself. If you work with a workers’ compensation lawyer, they can explain how the process works and why your claim is denied.
Where to File an Appeal of the Denial of Your Manufacturing Industry Workers’ Compensation Claim
You can appeal a denial at the Division of Compensación de trabajadores (DWC) office in the county where you live or where you received your injury to file your appeal form.
How to Challenge an Adverse Ruling on a Workers’ Comp Claim
You must complete and file an Application for Adjudication of Claim form from the DWC to appeal a workers’ compensation claim denial. The form is five pages long, plus one page of instructions.
After you complete the form, keep a copy for your records. You must serve a copy of the application to all parties. Typically, the only other party at this point is the claims administrator.
Information Required in the Application for Adjudication of Claim Form
You will need the following information to complete your Application for Adjudication of Claim form to challenge a denial of your manufacturing industry request for workers’ compensation benefits:
- Your case number. This number should be on the correspondence about the denial of your claim.
- Your contact information and Social Security number.
- The name of your employer and their workers’ compensation insurance company.
- The details of your injury or illness.
- Your earnings.
- Details of your disability periods (in other words, when your illness or injury impacted your ability to work).
- How much compensation you have received for the illness or injury.
- Your medical treatment.
- The reason for your disagreement with the denial of your claim.
If you are working with a workers’ compensation attorney, they can help you fill out this form.
When to File Your Application for Adjudication of Claim to Appeal a Denial of Benefits
You should file your Application for Adjudication of Claim as soon as possible because there are deadlines at each step of this process.
How to Request a Hearing in Your Workers’ Compensation Appeal
You can request a hearing by filing a Declaration of Readiness to Proceed. The first hearing you receive will be a mandatory settlement conference (MSC).
What to Expect at a Mandatory Settlement Conference (MSC)
You and your legal representative will go to court for a hearing, and the claims administrator or their attorney will also attend. The judge will talk with both parties to help them settle the dispute. If the case isn’t resolved at the MSC, it will be set for a trial in front of a different judge. An attorney can advise you on what you will need to prepare before the trial begins.
You must be present at the trial, whether you have a lawyer or not. Usually, the judge rules on the case within one to three months after the trial. You will receive a written decision by mail.
Petitions for Reconsideration
If either party, meaning you or the claims administrator, is unhappy with the trial judge’s decision, they can challenge the ruling by filing a Petition for Reconsideration. This form lays out the procedural history of the workers’ comp claim and the facts and laws that support the request for reconsideration of the trial court’s decision.
Workers’ Compensation Benefits for Manufacturing Industry Workers in California
According to the DWC, the five basic workers’ compensation benefits are:
- Gastos médicos
- Temporary disability benefits to partially replace lost wages
- Permanent disability benefits if you do not fully recuperate
- Beneficios adicionales de desplazamiento laboral
- Death benefits (for those whose loved one suffered a fatal work-related injury)
Workers in the manufacturing sector can pursue compensation insurance coverage for work-related injuries. If you disagree with a denied workers’ compensation claim for any of the benefits listed above, you can challenge the decision with an appeal.
A workers’ compensation lawyer from KJT Grupo de Derecho can help you pursue the benefits you deserve as an injured manufacturing industry worker. Call us today for a free consultation at (818) 507-8525.