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Workers’ Compensation Claims: Appealing a Denied Claim 

Having a workers’ compensation claim denied can be devastating for any person. Those who have been notified of a denial may wish to reverse the decision. Fortunately, the State of California allows those who have been denied the opportunity to appeal. By filing a claim, you could have the opportunity to have a hearing with the Workers’ Compensation Appeals Board who will hear both sides and make a decision on the claim.

The entire appeals process can be a complex and stressful event. If you or someone you know has received a rejected or denied claim, seek the legal counsel of a professional attorney that has experience in workers’ compensation claims.

Reasons Why a Workers’ Compensation Claim Will Be Denied

There are various reasons why a claim could be denied. Unfortunately, many insurance companies will deny claims in hopes that the injured worker will drop the claim. The following are some of the most common reasons why a workers’ compensation claim will be denied:

  • The injury was not work related
  • The injury did not occur during work hours
  • The injury occurred due to an accident at another job or company
  • Failure to seek medical attention for the injury
  • Time off work is not needed for the type of injury sustained

While these are valid reasons why a workers’ compensation claim will be denied, there are a multitude of other mundane reasons why a claim can be rejected. For instance, a claim can be rejected based on a lack of corroborative documents. If you have been notified of a denied claim, it is important to not settle. Seek the support of a qualified attorney who can support you through the appeals process.

How to Approach a Denied Claim

As previously mentioned, the State of California will allow you to request a hearing if your claim has been denied. Through this appeals process, you can dispute with the insurer that your claim should be accepted. Here, you will need to demonstrate that your injury should be covered under the policy’s terms.

Before requesting a hearing, you will need to file an Application for Adjudication of Claim. This will provide you with a workers’ compensation case number. When requesting a hearing before a Workers’ Compensation Appeals Board, you will need to file a Declaration of Readiness to Proceed.

Supportive Documents: Medical Evidence

Among the many reasons why an insurance company can reject a workers’ compensation claim, one of the most common involves medical disputes. An insurance company can request that you provide medical records or they can also request that you submit to an evaluation performed by another physician.

Obtain Legal Support to Fight a Denied Claim

While receiving a rejected workers’ compensation claim notification can be devastating, it is important to understand that it is not the final answer. The State of California allows for an appeal for a denied workers’ compensation claim. While the appeals process can be complicated and complex, the effort to pursue the claim can be worth the determination. Consider seeking the legal support of an experienced and knowledgeable attorney that has experience in dealing with denied workers’ compensation claims.

Attorney Albert E. Hirst has extensive experience in handling workers’ compensation claim denials and appeals. He is dedicated to assisting victims obtain financial compensation for their work-related injuries. Workers’ compensation claims are time sensitive; seek the support of an experienced attorney.