Why Was My Workers’ Compensation Claim Denied in California?

Getting injured at work is stressful all on its own. Even though we all know that accidents happen, it’s natural to worry about job security or retaliation from an employer. On top of the anxiety you’re already facing, you now also have to think about the workers’ compensation process in California. If you’re struggling to get your claim approved, working with a workers’ compensation attorney can get you on the right track.

At Moga Law Firm, we help injured workers get the compensation they are owed under California state law. For more than 25 years, attorney Scot Thomas Moga has built his reputation as an aggressive advocate for his clients. At our firm, we understand the dynamics that can shape a workers’ compensation case and make it difficult for employees to get what they deserve. Call us at 909-931-2444 to discuss your case with us now.

Understanding Workers’ Compensation in California

Workers’ compensation is a type of insurance that employers must carry for their employees. The program is overseen by the Division of Workers’ Compensation in the Department of Industrial Relations. In California, it covers medical treatment for all work-related illnesses and injuries, temporary disability benefits while you recover, and permanent disability benefits if you have permanent losses. While there are exemptions to the state’s insurance requirement, the vast majority of employers are legally required to carry workers’ comp insurance.

When an employee is injured, the workers’ comp process is meant to get them treatment and temporary income as quickly as possible. Unlike a personal injury claim, it does not require the victim to prove fault. Despite this, many employees do run into roadblocks when they attempt to file a claim.

Common Reasons Claims Are Denied

There are many reasons that companies deny workers’ compensation claims—some valid and some not. This is why we recommend working with a workers’ compensation lawyer to explore your options and stand up for your rights. Some of the most commonly reported denial reasons include:

• Late reporting or filing: In California, you have 30 days to report an injury to your employer to begin the workers’ compensation process. However, you should report the injury as early as possible to get it documented, begin treatment, and receive the compensation you are owed.
• Injury not work-related: The insurance company may deny the claim if they have reason to believe your injury is not work-related. This may occur if the injury you have doesn’t line up with how you say it happened, if the injury is not consistent with the type of work you do, or if there was a long gap between the injury and medical care.
• No medical evidence: If there’s not enough medical evidence to back up an injury claim, a victim may need to work with a workers’ compensation law firm to prove that they were injured and that it happened at work. Unfortunately, this often happens when an employee believes they are uninjured, only to realize later that they need medical care.
• Exaggerated injuries: If a company believes that an employee is exaggerating or falsifying injuries to get out of work or defraud their employer, they may deny the claim.

What to Do If Your Claim is Denied

It’s important to remember that not every claim denial is valid. At the end of the day, an insurance company is still an insurance company, and they’re out to protect their profit margins, You can follow the appeals procedure and advocate for yourself.

First, review your denial letter. The company should have explained why they denied your claim and what your appeal rights are.

Next, start gathering more evidence. If anyone else at work saw your injury occur, ask them if they’d be willing to give a statement—and then pass their name along to your workers’ compensation lawyer.

Finally, talk to your lawyer about filing an appeal with the Workers’ Compensation Appeals Board. You typically have one year from the date of your injury to appeal the insurance company’s decision, but again, it’s recommended that you do so as early as possible.

Get the Support You Deserve With Moga Law Firm

If you’ve been injured at work and you can’t get the compensation you’re owed, it’s time to talk to a workers’ compensation attorney. Call us at 909-931-2444 or reach out online to get started now.