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How to Appeal a Denied Workers’ Compensation Claim in the State of California

Employees in the State of California can typically receive benefits from a workers’ compensation claim if they sustained injuries or an illness due to a work-related event. Unfortunately, many employees can experience a denied claim. Many employers’ insurance carriers will reject workers’ compensation claims in their entirety or can sometimes not award the full amount available.

If your workers’ compensation claim was denied or you did not receive the full amount of benefits available to you, you should know that you have the legal right to an appeal. This article will highlight important aspects you should be aware of when appealing your rejected claim with the California Division of Workers’ Compensation Appeals Board. This agency will monitor and handle California’s workers’ compensation system and will also work to resolve disputes.

If you have any specific questions regard your denied claim or if you are unsure why your claim was rejected, seek the advice of a skilled attorney who has experience in dealing with workers’ compensation appeals. When it comes to workers’ compensation appeals, time is of the essence; obtain proficient support as soon as possible.

Rejected Claims Based on Missed Deadlines

Workers’ compensation claims have very strict deadlines that must be met accordingly. The failure to meet the required deadlines could easily result in a rejected claim. In order to receive workers’ compensation benefits in the State of California, you will need to report the injury to your employer or appropriate supervisor within thirty (30) days of when the injury occurred. For the most part, the injury date recorded takes place when the injury-causing event occurred or when you had been exposed to the harmful substance.

It is worth noting that there are certain injuries or ailments that transpire over the course of some time. Injuries such as a disease, that could typically take many months to develop, will not follow the same deadline. For developing injuries, the thirty (30) day deadline will not begin until the date the injured worker should have known about the condition as being work-related.

Rejected Claims Based on Injuries Not Related to Work

A workers’ compensation claim in the State of California will only be covered if the injury or ailment occurred due to a work-related issue. In essence, this will typically mean that a person will only receive benefits if he or she was performing tasks for his or her employer when he or she got sick or was injured.

According to California law, there are certain cases where an injury will not be covered because it is not considered to be a work-related injury. Common examples of this may include the following:

  • Being under the influence of an illegal substance when the incident occurred.
  • Suffering an injury that resulted from a fight the claimant instigated.
  • Driving to or from work, unless your job duties specify that you are paid for this. 

When Your Claim Has Been Rejected, Seek Legal Support

There are numerous reasons as to why a workers’ compensation claim can be denied. Some cases may be denied based on incorrect documentation or simple technicalities. Other causes for denied claims may involve the rejection of the injury or ailment as not being a work-related case. Despite the reason for the appeal, it is very important to appeal the rejection straightaway. Consult a professional attorney who can help you remedy the issue that caused the rejection or can otherwise help you understand where the problem is coming from. Seeking the legal support of a proficient attorney will also help you with regard to filing the appeal in a time-appropriate manner; which in itself can help you obtain a successfully approved claim.

Attorney Albert E. Hirst is dedicated to helping employees challenging rejected workers’ compensation claims. He is highly proficient and experienced in the field of workers’ compensation claim denials and appeals. Do not allow a rejected claim be the final outcome of your case; seek proficient legal support to help you challenge the denied application.