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Why did my employer’s insurer deny my workers’ comp claim?

On Behalf of | Jan 30, 2019 | Denied Claims, Workers' Compensation |

There are few in California who can afford to take time off work, especially when that time relates to a workplace injury or illness. If you are in this situation, you are certainly facing medical bills and other expenses related to your condition in addition to lost wages. Because of this, you may be shocked to learn that your employer’s workers’ compensation insurer denied your claim for benefits.

A denial for coverage for your injury or work-related illness can be a devastating blow. You may have reasonable concerns about how to keep your family afloat while you recover. You may even wonder if you will be able to continue with the necessary treatments and therapies your condition may require for a healthy quality of life. Your first step is to understand the reason why the insurer denied your claim.

Common reasons for claim denials

The letter from the insurer should state the reason for the denial, and this is the starting point for your appeal. In some cases, appealing a workers’ comp denial is a matter of supplying missing information or correcting a clerical mistake. However, it is possible that your benefit denial came because of another serious reason, including any of the following:

  • Your employer does not believe your accident or injury is work-related.
  • Your injuries do not qualify for coverage because they occurred during horseplay, while you were intoxicated or for some other reason.
  • You did not report your injury to your employer within the deadline of 30 days from your injury, but this may be difficult to tally if you have a slow-developing injury, such as carpal tunnel.
  • You did not file a claim for workers’ compensation benefits in time, or you failed to follow the instructions on the claim form.
  • You did not receive medical treatment for the injury or illness.
  • You did not provide sufficient evidence that the injury or condition relates to your job.

A denial of workers’ compensation benefits is not the final word, and you have the option of appealing the decision. Again, you will have another deadline to meet, and it is important not to let this one slip by without taking action. In fact, you may wish to enlist the assistance of an attorney who can provide many advantages to assist you throughout the appeals process.

Appealing a workers’ compensation denial involves an appearance before an administrative judge where you will provide documentation that supports your case. Your attorney can guide you in gathering that information and can represent you during the administrative hearing.