Injuries are unfortunate. Apart from the physical pain, they also put you through the financial burden and wage losses. Workers’ compensation insurance is meant to cover injuries and illnesses at the workplace and reduce your financial burden if not the pain and suffering. But there are several cases where workers’ compensation claims are denied. This is the worst possible scenario for any employee who has suffered an injury and has already been through a lot of mental agonies.
At the Law Office of James E. Latimer & Associates, we regularly deal with cases related to denial of workers compensation claims. Over the years we have seen insurers explore every possible means either to deny compensation to injured workers or under compensating them. We have fought for these claims and benefits and take pride in our success record.
How Your Workers’ Comp Claims Can Be Denied?
If your workers compensation claims have been denied it is important for you to get to the reason for this denial. You are likely to be issued a denial letter by the insurer. Oakland workers’ compensation attorneys need to know the reason behind the denial to help you file an appeal. Here are some common reasons under which workers compensation is denied –
- Not reporting injury on time – In the State of California, you need to report an injury within 30 days. Failure to do so may result in your claim being denied by the employer. You should inform your employer or supervisor immediately after the injury. In case the illness or injury develops gradually you need to inform as soon as you learn about it.
- Not filing the claim on time – You need to file a claim for compensation within one year of the injury or illness and beyond this, your claim may be rejected.
- Claim disputed by an employer – Your claim can be denied if your employer disputes the injury such as it happened outside the premises or your schedule job role, you were carrying the injury from the past or it resulted from horseplay.
- Injuries not covered under compensation – There are certain types of injuries such as those from fights and altercations that may not be compensable under the insurance program
- No medical treatment – You need to obtain proper medical care when you suffer from injury or illness. Self-medication, negligence with treatment or refusal to accept medical treatment may lead to denial of the workers compensation claim
- Injury not work-related – Employers and insurers often deny claims by citing that the injury or illness for which compensation is being sought isn’t work-related and you don’t have sufficient evidence to prove it.
Appealing Denial of Workers Compensation Claim
You shouldn’t lose heart if your claim has been denied by the insurer. The battle isn’t lost and we have successfully fought such cases in the past. What is most important in such cases is to file your appeal on time. The appeal should be filed with the Worker’s Compensation Appeals Board or the WCAB within 20 days of receiving the initial award from the local district. The board usually takes around 60 days to arrive at a decision on your claims.
It is important to remember that not all appeals are successful and you should appeal only when you believe there is a genuine error on part of the employer or the insurer in denying your compensation claim or you have new evidence that may tilt the decision in your favor. You should come to us for a free consultation with your denial letter and we shall closely examine the merits of filing an appeal.