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What to Do If Your Workers’ Compensation Claim Is Denied

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Posted By DAM Firm | February 19 2021 | Workers' Compensation

If you are injured at work in Riverside or anywhere throughout California, you should be entitled to compensation. The California workers’ conversation system is designed to be a type of “no-fault” insurance. This means that an injured worker should receive benefits for their medical bills, lost income, and disability benefits in the event they sustain an injury at work, regardless of which party caused the injury. However, there are various reasons why an employer or insurance carrier may deny a workers’ comp claim. Some of these reasons are legitimate, while others test the boundaries of acceptable denials. Here, we want to discuss what you can do if your workers’ compensation claim is denied in Riverside.

Figure out the reason for the denial

If you find out that your Riverside workers’ compensation claim has been denied, do not panic. We want you to immediately consider seeking assistance from a skilled workers’ comp attorney in Riverside who can help you with your claim. The first step is to determine why the claim was denied. There are various legitimate reasons why an employer or an insurance carrier may deny these claims, including the following:

  • The injury was not related to a work activity
  • The injury occurred during non-work-related hours
  • The injury was caused by a third party
  • The injury victim did not seek medical treatment
  • The injury victim did not need any time off
  • The injury victim was impaired by alcohol or drugs at the time of the incident occurred
  • The injury occurred due to horse playing

However, just because an employer says that they have a legitimate reason to deny a claim does not mean that they are right. When you find out the reason for the denial, you now have the ability to address any concerns.

Make an appeal

Appealing a workers’ compensation claim in California can seem intimidating, but it is not. First, you will need to request a hearing with the Workers’ Comp Appeals Board (WCAB). In order to request this hearing, you or your attorney need to fill out a form called a Declaration of Readiness to Proceed (DOR).

There are various steps involved in the appeals process, and the WCAB will decide whether or not they need to set a “priority conference” in order to expedite the appeal or whether the appeal will move at a normal pace. At a conference, a WCAB judge will try to resolve the issues between the injured worker and the other parties involved. If the issue cannot be resolved, the judge will set a trial date in the future. The judge will also establish a discovery plan so that both sides can produce evidence to help determine the facts of the case.

Contact a workers’ compensation attorney in Riverside

If you or somebody you care about has sustained an on-the-job injury and are having trouble securing your rightful workers’ compensation insurance, you need to speak to an attorney as soon as possible. These claims can become complicated, but the sooner you get out ahead of the situation with an advocate of your own, the more likely you will be to receive the compensation you need. An attorney will have the resources necessary to conduct a complete investigation into the incident to determine exactly what happened and fight back against aggressive insurance carriers and employers.

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