Appealing a Denied Workers’ Compensation Claim in California

Our Pasadena Workers’ Compensation Lawyer Explains the Appeals Process

An Attorney and a Client Discussing Contesting a Trust AmendmentWorkers must rely on workers’ compensation benefits for maintaining an acceptable standard of living after suffering a workplace injury or illness. Benefits from California’s workers’ compensation system may also be essential for obtaining medical treatment. However, like with many insurance matters, workers’ compensation insurers may unfairly deny a claim. When this occurs, workers and their families may be unable to pay their bills and receive essential medical care. Fortunately, you may be able to appeal a denied workers’ compensation claim under the right circumstances.

Our Pasadena workers’ compensation lawyer can help injured workers and their families review options for appealing a denied claim. You can learn more about our workers’ compensation services on our website. In addition, you may also contact us for a free initial consultation.

How to Appeal a Denied Workers’ Compensation Claim in California

In some cases, the first step to resolving a workers’ compensation denial is to contact the insurer. You might need more information on the denial and a chance to ask the insurer if it will reconsider its decision. Many workers’ compensation claims are denied because the insurer believes the injury or illness is not eligible for benefits. However, there are also cases where the insurer did not have enough information to properly assess eligibility for an injury or illness.

If the insurer will not reverse its decision, then you may need to request a hearing with the Workers’ Compensation Appeals Board (WCAB). It helps to work with a workers’ compensation attorney during this process. If you are working with an attorney, then he or she can file the Application for Adjudication of Claim and Declaration of Readiness to Proceed forms.

Beware that filing the wrong type of form can lead to a dismissal of your case. You would have a limited period of time to correct the mistake and file the correct form. Experienced attorneys can help you avoid mistakes during the filing process.

Your attorney can represent you at a hearing to try and reach a settlement with the insurance provider. If a hearing does not reach a settlement, then your attorney may also represent you at a trial. Depending on the outcome of the hearing or trial, you may be able to recover your denied benefits. Each case is different and there are a number of reasons why an insurer may deny an initial claim.

Why Do Insurers Deny California Workers’ Compensation Claims?

Insurers may deny a workers’ compensation claim. Below are some of the most common reasons for workers’ compensation denials:

  • The cause of the injury or illness. In California, you cannot recover workers’ compensation for self-inflicted injuries or injuries that arose from fighting. Workers’ compensation does not cover injuries caused by drug or alcohol intoxication.
  • Delays in the filing process. There are procedural steps for filing a workers’ compensation claim in California. Failure to meet deadlines or other filing requirements could result in a denial of benefits.
  • The injury or illness is not eligible. You cannot recover benefits for certain types of injuries, such as those caused by a preexisting condition. In addition, you can only recover benefits for injuries or illnesses caused by your work duties. If the injury or illness occurred outside of the scope of your employment, then you are not eligible to recover benefits.
  • Filing errors. Workers’ compensation insurers may deny a claim if they do not have enough information about the cause of the injury or illness.

We may be able to help you successfully appeal your claim for benefits. If you have questions about your potential options for filing an appeal, we encourage you to reach out to us for a free consultation.

Contact Our Pasadena Workers’ Compensation Lawyer for a Free Consultation

Questions about appealing a denied workers’ compensation claim in California? The Aslanian Law Firm, PC can help. To schedule a free consultation with Pasadena workers’ compensation lawyer Greg Aslanian, call (626) 345-7210 or use the contact form on our site.