Workers’ compensation is an insurance benefit. As such, it is frequently denied to workers. It’s no secret that insurance companies want to keep from paying out benefits if they can. They will use whatever tactics they can to deny claims.
When you’ve been denied, it’s a worrying time. You are stuck recovering from an injury and getting no assistance. Medical bills are piling up, and you’re missing work. You need the benefits to stay afloat, so what are your options? Once you’ve been denied, you need to file an appeal and go to a workers’ compensation trial.
Scheduling the appeal alone may be enough to get insurance companies to comply. Focused on their bottom line, companies may see the trial as too expensive to bother. They will have to pay a lawyer to gather evidence, build a case, and argue the case at the trial. It may be easier and less costly for them to grant your request.
Insurance companies will use a few different methods to deny your claim. One tactic is to argue that the injury didn’t happen on the job. Any technicality can be an excuse to deny your claim. Perhaps you were on lunch in the parking lot. The driver of a forklift, not looking where they were going, hit you, causing an injury. The fact that you were not directly “on the clock” at that moment could be an excuse to deny your benefits.
Another reason to deny the claim is that the injury wasn’t substantial enough to warrant a payout. The insurance company is essentially saying that your injury isn’t “worthy” of workers’ comp. Documentation is your best weapon against this argument. Medical bills, incident reports, time off work – anything that you can produce will show how impactful your injuries were.
Once again using technicalities, insurance companies may challenge the application itself. Any unfilled line or unchecked box can be cause for denial. This is why you should run your workers’ compensation application by a lawyer before filing it. An experienced, skilled eye can locate any areas you missed. Moreover, they can help with the argument itself. Something as simple as the phrasing of your story could be misinterpreted. Lawyers know how insurance companies think, and they can help you choose the correct words that can increase your chances of a positive outcome.
Workers’ Compensation Trial Process
Insurance Lawyer Interview
Before the trial, the insurance lawyer will interview you. This is called a “deposition.” They want to hear your side of the story, gathering evidence for their argument. The interview will likely be professional and courteous. They are just getting the information they need to begin investigating their side of the case.
Before this interview, prepare with your lawyer. They have already gone through the denial paperwork, so they know the kinds of questions you will be asked. They can prepare you for how to answer, what to say, and what not to say. Your interview with the insurance lawyer should not be contentious, but you should be aware that they will use anything you say to build an argument against you.
Like any trial, there will be a period where both sides gather their evidence. Your lawyer is building a case for you, and the insurance lawyer is building a case against you. Each side is looking for information that will strengthen their arguments. This could come in the form of documentation and eyewitness testimony. They may call your doctors to get specifics on your injuries. Whatever they can use to fortify their position, they will.
Although California uses the word “trial” in a workers’ comp appeal, it is more like a meeting. It will take place in an office, not a courtroom. The only attendees will be the judge, someone recording the trial, the lawyers, you, and any relevant witnesses. There won’t be an audience or any other typical courtroom trappings.
The process, however, will operate much like a courtroom trial. Each lawyer will be given the opportunity to make opening statements, where they will lay out what they intend to prove. Evidence is then presented on both sides. Witnesses may be called and cross-examined.
You could be called to testify, telling your side of the story. If so, you will also be cross-examined by the opposing lawyer. This process should not be intimidating, as you will have already prepared with your lawyer. Just as in the initial deposition, your lawyer will prepare and practice with you, readying you for the kinds of questions you will be asked and how you should answer.
After the trial is over, the judge will make a ruling, just like a courtroom judge. You may have to wait a while until you receive the verdict. This is another reason why it’s helpful to have a lawyer. They can stay on top of the process and keep you informed. If necessary, they can also help nudge the process along.
If you’ve been injured on the job, call us today. Whether you’ve been denied workers’ comp or haven’t yet applied, we can help you out with a free consultation. You can contact us online or call (714) 909-2609 today.