When a Californian has suffered a workplace injury, gotten ill from the job or is suffering a condition due to the work they do, workers’ compensation can help them while they are unable to work and are getting treatment. This is an integral part of covering medical expenses, lost wages and other problems stemming from the injury or malady. However, a nightmare scenario for many people is if their claim is denied. Fortunately, there are steps that the worker can take to try and get workers’ compensation benefits even after a denial.
It is not unusual for a claim to be denied or delayed by the insurance company. When this occurs, there is no reason to panic. It is important to be organized. Accruing the necessary medical documentation; recording all expenses that have accumulated from the injury or illness and lost time on the job; finding witnesses who can give statements about the issues; and keeping a comprehensive file with the documents that support the claim are all steps to take when appealing a denied claim.
The best-case scenario when there is a workplace injury or illness is that the insurance company will approve the workers’ compensation benefits. If that does not happen, it is an unavoidable circumstance that the case will be worker vs. insurer. An “Application for Adjudication of Claim” must be filed. Then, a workers’ compensation administrative law judge will hear the case. The judge will decide based on the evidence. It could be an approval or a denial. If there is a denial, it is still possible to appeal to the Workers’ Compensation Appeals Board.
The denial of a workers’ compensation claim does not automatically imply that the case is over. People who have suffered workplace injuries or become ill from their work should apply for workers’ compensation benefits. If the claim is denied, it is imperative to exhaust all the options to appeal. A legal professional who understands the workers’ compensation process and is experienced in helping clients facing denied claims can give advice and assistance with the case from the beginning through the appeals process.