Denied Workers' Compensation Claims in Riverside
We Fight Against Claim Denials
It’s bad enough that you were injured or became ill because of your job conditions, but now, your claim was denied by your employer’s workers’ compensation carrier. Despite their denial, you have an absolute legal right to appeal their decision. Just because the claims administrator has determined your medical condition shouldn’t be covered by workers’ compensation, doesn’t mean their decision is final. Still, you must take deliberate action if you want to fight the denial.
If you’ve already filed a workers’ compensation claim and you accept the denial notice and do nothing further, you will lose your right to pursue your claim. While you can call your employer’s insurance company to ask why your claim was denied, it may be risky and further jeopardize your right to collect benefits. Before you do, you may wisely consider involving a skilled, competent workers’ compensation attorney.
Because your employer’s workers’ compensation carrier’s foremost interest is in not paying your claim, and they won’t if they can get away with it, they will look for reasons to deny it.
Or in some cases, through human error — yours or theirs — your claim may be denied because of an administrative mistake. The workers’ compensation system has specific rules and requirements for reporting a work-related injury or illness, stringent, inflexible deadlines for filing a claim, and complex forms to fill out. If anything in your benefits’ claim process is not done correctly or not submitted within time deadlines, your claim will probably be denied. Your employer’s workers’ compensation insurance company must send you a Notice of Denial within 21 days of receiving your claim. If they don‘t, they can be held responsible for interest, penalties, and attorney fees.
If your claim was denied because of an administrative reason, you may be able to resolve the denial by contacting the insurance company so you can correct the mistake. If that fails, you will likely need an attorney to pursue an appeal of your workers’ compensation claim denial.
When You Filed a Legitimate Workers’ Compensation Claim, and It Was Denied, Skilled California Workers’ Compensation Attorney Brian Freeman Will Appeal Your Right to Win Benefits
Appealing A Workers’ Compensation Claim Denial is A Complicated Legal Process
When you receive your disqualification notice, CCR §10840 will be included. To appeal a benefits disqualification, you must complete and return the form within 30 days of the date on the notice. When a workers’ comp claim is denied, it means the claims administrator believes your injury is not covered by workers’ compensation. In this case, you have a right to challenge the decision but must follow stringent, inflexible established deadlines. If you appeal a denial of your claim, your case will be heard by a workers’ compensation administrative law judge (WCJ) at one of California’s 23 local offices or by satellite.
There are specific ways to file an appeal including:
Petition for Reconsideration & Petition for Removal (CCR §10840) — Petitions for reconsideration, removal, or disqualification and answers must be filed with a Workers’ Compensation Appeals Board district office or with the office of the CCR §10840.
CCR §10840 (Labor Code §5950, et seq.) — A claimant who has been denied a workers’ compensation claim by a final decision of the Appeals Board CCR §10840 district in which the party resides for review.
Workers Compensation Lawyer, Inc. Has Successfully Handled Appeals Board Cases Involving Judges and Intimidating Court Proceedings
Without legal experience, judges and court proceedings can be baffling and intimidating. But not to Brian Freeman, the founder of Workers’ Compensation Lawyer, Inc. For over a decade, Attorney Freeman has worked hard to win the monetary compensation of the “Average Joe” when his clients have been seriously injured because of another’s recklessness or negligence. As a California Board Certified Workers’ Compensation Specialist, Attorney Brian Freeman has passed rigorous state exams and gained specialized education and training in workers’ compensation law. Every year, he completes continuing education in this area of legal expertise.
If your claim has been denied, it’s not yet time to despair. In some cases, the denial is easy to repair. In other cases, appealing a denial may involve filing complex forms on time and having your case heard before a judge.
Failure to Report Your Injury or Illness to Your Employer
In California, the first step in pursuing workers’ compensation benefits is to report your work-related injury or illness within 30 days of being injured or becoming aware of an illness. If you didn’t report the incident or illness, your claim will be denied.
Failure to Meet the 30-day Deadline
If you do not report your injury or illness to your employer within 30 days, your claim will probably be denied.
Failure to File A Workers’ Compensation Claim Within A One-Year Deadline
California law requires injured workers to file a CCR §10840 within one year. Failure to file in time may disqualify you. However, exceptions to this may include the court‘s schedule or other extenuating circumstances that can extend beyond the one-year deadline. Other extenuating circumstances may include an injured workers’ lack of knowledge of how to file a claim or when an employer has misled an employee about workers’ compensation law.
Failure to Seek Proper Medical Treatment
If you didn’t receive medical treatment commensurate with what you reported as your harm or didn’t seek any medical care, the workers’ compensation insurance company may believe you’re falsifying your claim and deny it. To protect yourself, even if you didn’t believe your injury required medical care, you should still see a qualified workers’ compensation physician.
Accident Report and Initial Medical Report Conflict
If the injury or illness you reported to your employer isn’t consistent with the initial physician’s medical report, the insurance company will be suspicious of your claim.
For instance, if you claim you had an on-the-job concussion, but a specialist can find no brain injury or symptoms consistent with a concussion, your accident report may be viewed as inconsistent with a medical evaluation and, therefore, deny your claim.
Injury or Illness is from A Pre-existing Condition
If you had a pre-existing non-work-related injury or illness but claim your workplace is responsible, your claim will usually be denied. Even if a new injury exacerbated a pre-existing condition, your claim may still be denied.
Alcohol or Drug Test Refused or Failed
If you either refused or failed a drug or alcohol test, your claim may be considered invalid and denied. While California’s workers’ compensation is technically a no-fault system, the no-fault clause does not apply to workers who were injured while under the influence of drugs or alcohol.
Willful Negligence or Recklessness
If evidence clearly suggests that you were engaging in reckless or careless conduct that resulted in an injury or illness, this will likely be a reason for a claim denial.
Undetermined Cause of Injury
If the cause of an injury or illness cannot be identified, your employer’s workers’ compensation attorney may claim the incident was not work related.
You Filed A Claim After You Were Terminated
If you only filed a claim after you were fired, an insurance company may consider your claim retaliation. Your claim may be viewed as irrelevant because if you didn’t report an incident while employed, it must not be serious. But if you believe you were fired in retaliation for filing a workers’ compensation claim, you may have legal recourse for damages and/or your job back.
Refusal to Make A Recorded Statement
An insurance company may have grounds to deny your complaint if you refuse to make a recorded statement. But complying with such a request could be detrimental to your case. When involved in an insurance investigation, you should never make a recorded statement without the advice of a qualified workers’ compensation attorney.
Not Completing Paperwork Properly, Fully and Accurately
It is imperative that you fill out all required forms in a complete and accurate manner, leaving no requested information or details out. While a denial on this basis can be corrected, it is likely to be considered grounds for a denial.
If your claim was filed only on the basis of your word, the insurance company may be suspicious and deny your claim, but it depends on various factors. However, depending upon the circumstances, this may or may not disqualify your claim.
If your employer’s workers’ compensation carrier has reason to believe your work injury or illness claim is fraudulent, they will have grounds to deny it. If you’ve provided information inconsistent with your injury or illness claim or you’ve been observed engaging in an activity not possible if you were actually injured the way you reported, your claim will be denied. When deemed necessary, your employer’s insurance company will use their resources to verify whether your claim is valid, honest, and accurate.
All details, facts, and reports related to your injury or illness must be presented and clearly communicated to both your employer and their insurance company. If you have not fully provided information, your claim will likely be denied.
Spinal Injuries $206,000
We have recovered a settlement for a client that suffered from spinal injuries while working on a home improvement project pulling a pallet.
Psych Injury $125,000
We have recovered a settlement for a client that suffered from a psych injury due to a traumatizing event; the defendants denied the claim.
Cumulative Trauma - Laborer $123,000
We have recovered a settlement for a client that suffered from Cumulative trauma due to repetitive movement.
Cumulative Trauma Injury - Orthopedic $120,000
We have recovered a settlement for a client that suffered from various cumulative trauma injuries due to body parts wearing out over 20 years of labor.
Cumulative Neck Injury $120,000
We have recovered a settlement for a client who suffered from a cumulative neck injury.
Spinal Injury $100,000
We have recovered a settlement for a client who suffered from neck and back injuries due to operating a caterpillar.
Back & Arm Injury $95,000
We have recovered a settlement for a client that suffered from a specific injury to the back and cumulative injury to arms.
Back Injury $70,000
We have recovered a settlement for a client who suffered from back injuries due to a car accident.