The law requires certain employers in California to carry insurance that covers injuries or illnesses related to a worker’s job. If you become ill or injured on the job, you may file a claim for workers’ compensation to receive benefits such as reimbursement for medical bills, lost wages and job training if necessary. For many injured workers, these benefits are a blessing when an injury prevents them from returning to work right away.
Unfortunately, some companies that provide workers’ compensation coverage are just like many other insurance companies. They are businesses that are hoping to make money and reluctant to pay out on claims. For this reason, it is not unusual for an injured worker to learn that the insurer has rejected his or her claim for benefits.
Why was my claim denied?
Since the workers’ compensation process in California can be complex and confusing, it is possible that the insurer denied your claim for an administrative reason. Perhaps you completed the forms incorrectly or missed the deadline for filing your claim. It is possible that there is some question about the exact date when your injury occurred, especially if the symptoms did not show immediately. Other reasons an insurer may use to deny your claim include the following:
- You did not report your injury to your employer within the legal timeframe.
- Your employer does not support your claim that the injury or illness occurred at work.
- Your employer believes your injury resulted from blatant disregard for safety protocol.
- You did not provide proof that you saw a doctor or completed the treatment your doctor recommended.
- Your employer’s insurer does not cover your particular kind of injury.
You should be especially aware of any deadlines for appeal the insurer included in the letter they sent explaining why they denied your claim. The denial of your claim could simply be an easily correctable error, but you may still find yourself battling to get the insurer to come to an agreement about this. It is seldom as easy as making a change in the insurer’s computer records, and you may have to take your claim through the appeals process.
If this is your next step, you will want to be thoroughly prepared to support your case. Many employees facing disputes with a workers’ compensation insurer find that the skill and experience of an attorney is invaluable.