Why Was My Workers’ Compensation Claim Denied?

Nothing adds insult to injury quite like receiving a letter stating that your workers’ compensation claim was denied. Recovering from your injury is difficult enough, not to mention you’ve already spent hours filling out paperwork to receive the lost wages and medical reimbursement you need. There are a number of reasons why your workers’ compensation claim may have been denied, and figuring out what that reason is will be the first step towards filing an appeal.

Why was my claim denied?

You didn’t report your injury on time

In California, the deadline to notify your employer of a workplace accident is five days after your injury. What’s more, if you don’t report an injury as soon as it happens, the insurer may assume you weren’t really that hurt.

You didn’t file a claim on time

In addition to notifying your employer, you also need to submit your workers’ compensation paperwork in a timely manner. In California, you need to file your DWC-1 form within 30 days of your injury.

You have a pre-existing condition

If you have an old injury that was aggravated by an accident at work, you will need sufficient medical evidence to prove that the aggravation was indeed caused by performing your job duties.

Your employer has disputed the claim

Employers often look for reasons to deny that an employee’s injury happened at work. Accepting liability means his or her insurance premium goes up. To prove your case, you may need witness accounts or a statement from your doctor.

You were under the influence of drugs or alcohol

When you go to the doctor for your injury, your employer can require that you are tested for drugs or alcohol. If you were under the influence at the time of your accident, your claim will most certainly be denied.

You haven’t received medical treatment

In order to file for workers’ compensation, you need supporting medical records to prove the extent of your injury. If you didn’t see a doctor after your accident, the insurer may accuse you of faking your injury.

Your injury was not witnessed

If no one was around to witness your accident, insurers will try to use this against you. While you can’t change the past, you can gather statements from your supervisor and co-workers to whom you reported your injury after it happened.

How do I file an appeal?

If your workers’ compensation claim was denied, you’ll need to file an appeal in order to collect your benefits. The denial letter you got in the mail may have information about how to appeal the denial as well as the deadline in which you must file, so read it carefully.

The first thing you need to do when appealing the denial of your claim is to file an Application for Adjustment of Claim. You may have already done this when filing the original paperwork for your workers’ compensation claim. Then you’ll need to submit a form called the Declaration of Readiness to Proceed. Once the proper forms are in place you’ll be able to request a hearing in front of your local Workers' Compensation Appeals Board judge.

Before your appeal reaches trial, a pre-trial conference may be scheduled where the judge will listen to both sides of the story and help you try to resolve the issue. If an agreement cannot be reached, the judge will set the matter for trial. However, most disputes are settled at the pre-trial conference.

A workers’ compensation attorney can help

Your claim was already denied once. Why prolong the wait for your benefits by attempting to navigate the appeals process alone? While you don’t need a workers’ compensation attorney to file an appeal, having one will give your claim the best chance at success the second time around.

At the Law Offices of Gerald D. Brody & Associates, we can advise you on the steps to take and the documents you’ll need to prove your case. What’s more, we’ve dealt with countless claim denials and know all of the moves employers and insurers try to pull to deny responsibility for a worker’s injury. They don’t stand a chance against us. Call us today to schedule your free initial consultation. Your recovery depends on it