What to Do If Your CA Workers’ Comp Claim Is Denied

For injured California workers and loved ones who are counting on workers’ comp benefits, it can be disheartening when a claim is denied by the insurance carrier. If your claim has recently been denied by the insurance carrier, do not lose hope, even if your claim was subjected to a total denial.

It is still possible to receive the benefits you deserve by hiring an Orange County workers’ compensation attorney. Your lawyer will know how to use the legal system to effectively advocate for you and fight the legal reasoning used to justify a denied claim.

Here are a few ways that your attorney can help you win a denied workers’ comp case on appeal.

Your Lawyer Will Look at the Precise Reason for the Denial of Your Claim

The legal justification for a workers’ comp denial will be based on the specific facts and circumstances of the claim and injury suffered. Put another way, every situation is unique, but there are some common reasons for why a claim is denied.

Some common reasons include:

• Deadlines were missed or needed reports were not filed
• An unauthorized medical provider was used
• Medical care was not sought appropriately
• The employer claims that the injury or illness was not work-related

There are many other reasons for denials, but know that some research suggests that claim denial can be quite frequent. For example, a study of workers’ comp denial found that nearly 13 percent of patients studies had their claims either “denied” or “temporarily denied pending investigation.”

Your lawyer will look to the specifics of your case and claim, before working to prove that the denied status is legally incorrect by shifting the burden of proof.

As the Claims Applicant, You Have the Legal Burden of Proof on Appeal

It is your attorney’s job to prove that it is “more likely than not” that your workplace injury meets the California standard of an injury that “arose out of” and in the course of employment.

Broadly, this means your attorney must provide evidence on appeal that demonstrates your injury justifies workers’ compensation coverage and benefits. An experienced attorney will have a proven track record of making arguments that successfully demonstrate it is more likely than not that you deserve workers’ compensation benefits.

There are exceptions to this general rule that will shift the burden of proof onto the insurance carrier or employer, but in either case, your attorney will aggressively advocate for your right to receive benefits. As you can see, it is difficult (if not impossible) to make these legal arguments on appeal without the help of an experienced attorney.

At The Ledger Law Firm, we have earned national recognition as a proven personal injury and workers’ compensation law firm that has recovered millions in compensation for injured victims and workers.

For more information about our firm and how we can help you if a workers’ comp claim has been denied, contact us online for a legal consultation today.