4 Common Reasons for a Workers’ Comp Denial

Workers’ compensation does not come from your employer. Your employer pays for it, yes, but it is an insurance benefit. It comes from insurance companies, and we all know how much they don’t want to honor your claim.

Denying claims is baked into an insurance company’s business model. They take in as much money as they can, and they do their best to keep from spending money whenever they can.

Often, an insurer will look for any excuse to deny a worker’s comp claim. Valid or not, here are some excuses they will use.

  1. Using Timing Against You

The window to file your claim can be brief. First, you have a limited amount of time to report your injury to your employer. Normally, insurance companies want to see that you made this report immediately. Next, you have about 30 days to officially file your claim with the insurer.

Both requirements sound reasonable up front, but they do not account for the specifics of your situation. You may be too injured to report to your employer, needing instead to be rushed to the emergency room. The injury itself could leave you incapacitated, unable to properly file within 30 days.

If you haven’t been able to make a timely workers’ comp request, speak with an attorney. They may be able to help you plead for more time, getting you the benefits you need.

  1. Using Employer Statements

Sometimes, your employer claims that you don’t deserve benefits, and the insurance company goes along with whatever they say. Other times, the insurance company can twist or nitpick an employer’s statement, using it as an excuse to deny your benefits.

Either way, no one should speak for you, and you know what happened. Make sure your attorney disputes any statements that block your workers’ comp.

  1. Claiming the Injury Doesn’t Deserve Compensation

Insurance companies can nitpick virtually any detail in your claim. They may tell you that your injury doesn’t qualify based on where it took place. Perhaps they say that the injury itself isn’t worthy of coverage. They can also blame the injury on you, thereby bypassing the need to pay out your benefits.

  1. Claiming You Didn’t Seek Treatment

Insurers want paperwork of your event, and the best way to secure that record is through medical documents. If you don’t seek treatment, you could be easily denied benefits.

Even when you do get medical help, insurance companies can comb through the documents and look for excuses to withhold your benefits. They can claim that you didn’t seek proper treatment or that you should have gone to more doctors.

What to Do Once You’ve Been Denied

Whatever the circumstances, if an insurance company denies your workers’ comp claim, you must file an appeal.

In California, there are specific steps you must take after filing your appeal. First, the insurance lawyers will interview you, attempting to uncover all the facts of the case. From there, you must gather all necessary evidence to prove your claim. Then, you will attend a workers’ compensation “trial.”

Don’t let that name intimidate you. The trial is more of a meeting, taking place in an ordinary office. There will be a judge and someone transcribing the event. During this meeting, you can present your evidence, call on witnesses, and so forth.

An attorney will be invaluable during the appeal process. They can help you prepare for both the interview and the trial, and they can help you gather all the best evidence to prove your case.

If you’ve been denied workers’ comp, call our office today at (714) 909-2609 to set up a free consultation. You can also contact us online.

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