Workers’ compensation insurance protects virtually every worker in California. Workers’ comp denied claim might be the result of missing deadlines, disagreements about whether the injury is work-related, or strict state regulations. If your workers’ compensation claim is denied, you have the opportunity to submit an appeal. There are a lot of moving parts, and you have a lot of dates by which you need to get this done.
Reasons Why Workers’ Comp Is Denied?
When a workers’ compensation claim is made, insurance companies often look for anyway to turn it down. Some of the most common reasons that claims are turned down are:
- Skipped timelines: If you get hurt on the job in California, you must tell your boss in writing within 30 days. You have one year to file the claim. Failure to do so can result in a workers’ comp denial.
- Dispute about the nature of the injury: When a worker says an injury happened at work, there must be enough proof. Most of the time, medical documentation is the best way to back up the claim.
- The claim was sent in after you quit your job: Most of the time, an insurance company won’t pay a claim that was made after you quit, were laid off, or were fired. But if you can show that there was a good reason for the delay, you may be able to win an appeal.
How to Appeal For a Denied Workers’ Compensation Claim In California?
- First, you have to submit a Request for Judgment of Claim with the DWC office in your county of residence (or the county where your injury or illness happened).
- The DWC office will then let you know that they have received your application and give you a case number. Hold on to these papers.
- You must file a Statement of Readiness to Proceed if you want to ask a judge for a hearing. Then, you will have to go to a hearing called a Mandatory Settlement Conference.
- You, the claims administrator, and/or your lawyers will need to be at the hearing. At the MSC hearing, the goal is to settle.
- If the MSC hearing doesn’t lead to a settlement, the judge will set a date for your court hearing, which will be in front of another judge.
- After the trial, the judge will reach out to you by mail with his or her decision about your case. This usually takes between 30 and 90 days.
- If you disagree with the judge’s decision, you can file a Petition for Reconsideration. This will cause the judge’s decision to be looked at again.
Want To Hire A Workers’ Comp Lawyer For Workers’ Compensation Appeal?
Be aware that even though your request for workers’ compensation benefits are denied, you still have other options available to you. We are aware you are now dealing with a challenging circumstance; as a result, we offer all clients thorough and empathetic legal services if your workers’ compensation claim is denied. Our staff is here to listen to your concerns and provide the guidance you require to reach decisions on your situation.