Workplace accidents are still a common thing despite efforts by the authorities and employers to make workplaces safe. Whenever they occur, workplace accidents often threaten an employee’s earning capacity as they may result in serious, life-long injuries.
Employees injured while on the clock are eligible for workers’ compensation benefits. In fact, the US government makes it mandatory for every employer to have workers’ compensation insurance for their employees. In the event of a workplace-related injury or illness, employees can receive medical and wage replacement benefits.
How does workers’ compensation work?
Workers’ compensation, also referred to as workers’ comp, is a type of insurance that covers an employee’s medical costs and wages whenever they get ill or injured due to a workplace-related illness or accident. In exchange, such an employee is required to give up their right to sue the employer for the workplace accident.
Reasons why a workers’ compensation claim can be denied
To be eligible for worker’s compensation benefits, California employees must ensure that their claim meets certain requirements. Such conditions include:
• The employee must have been injured while carrying out work-related activities.
• The employee must have suffered an occupational illness or disease that resulted from their job.
• The injury or illness must have solely been caused by work-related activities and arose during the course of employment.
Most employees think that the process of receiving workers’ comp benefits is smooth sailing. However, this could be far from the truth. An employee or their insurer can deny your workers’ comp claim, citing various reasons. The main reasons as to why your claim might be denied include:
• The injury suffered was not work-related or resulted from a pre-existing condition.
• The injury occurred outside the workplace.
Mostly, the denial of a workers’ compensation claim will be based on the facts surrounding the injury. However, there could be a host of other reasons that could see your claim disputed and ultimately denied. Some of these reasons include:
• The filing process of your injury was delayed or the injury was not formally reported to the employer or supervisor within the deadline.
• You failed to seek medical treatment in a timely manner.
• Your injury was not “severe” enough for you to be compensated.
• You sought medical treatment from a doctor other than the one recommended to you by your employer.
• Your claim was not supported by medical records and documents.
• A blood test indicated that you were under the influence of alcohol or drugs when the injury occurred.
What to do after a workers’ compensation claim denial
Employees whose workers’ compensation claim is denied are often left frustrated and wondering where best to look for help. As dispiriting as the news of the denial of your claim can be, there are steps you can take to ensure that you receive the compensation you deserve.
Appealing your workers’ compensation denial is usually the most obvious legal step to take. In California, appealing the denial of your claim involves requesting a hearing before your local Workers’ Compensation Appeals Board judge.
By listening to both sides of the case, the judge makes a decision on whether your employer’s insurer must accept your workers’ comp claim.
Need an experienced lawyer for your workers’ comp claim denial appeal?
At Guy Levy Law, we understand the agony that injured workers go through, especially when their compensation claims are denied. If you plan on appealing the denial of your workers’ compensation claim, working with an experienced lawyer may guarantee the desired results.
Our lawyers are experienced at handling workers’ compensation cases and can help you receive the compensation you deserve. Contact us today for a free case evaluation to understand your legal rights.
