What To Do When Workers Compensation Claim Got Denied?

Generally, workplace injuries are covered by the workers' compensation insurance of the employer. The workers’ compensation system is a complex process, under which the claim of the victim could be turned down due to several reasons. Each insurance company indirectly fights with the injured worker with the purpose to deny the compensation benefits as much as possible.

The insurance companies usually deny the work injury claims all the time to save their money. Where the objective of a work accident attorney is to help the injured get the compensation that he or she deserves for the injury, their insurance company works with the motive to deny the benefits. Insurance companies generally make the initial determination that whether the work injury claim should be approved or denied. Here are some steps that one can take after a compensation claim denial to fight for the benefits that one deserves:-

Appealing for the workers' compensation denial:-

Before taking any legal step, you can also contact your employer and the workers’ compensation insurance carrier of your employer to discuss the reason behind the claim denial. In case the denial is due to lack of any clerical error, document, or mistaken paperwork, then it is easy to clear this up. But if it is your employer or the insurance company who is responsible for this, then the first step that one should take is none other than appealing for the workers' compensation denial.

Each denial letter generally has a deadline for filing the appeal. This deadline is determined by state law. You can file for the appeal within 30 days of receiving the compensation denial letter. This appeal is known as the Petition for Removal or Petition for Reconsideration depending on the reason.

Petition for Removal:-

A Petition for Removal can be filed when the decision regarding the compensation denial was taken by the judge before the trial. Such decisions are related to discovery, hearing time and location, evidence, or similar issues. Issues that can be raised in a Petition for Removal are:-

• Reconsideration is not the right action
• the original decision is prejudicial
• the decision will result in great harm

Petition for Reconsideration:-

In California, a worker can file for the Petition for Reconsideration when the decision of the denial was made by the judge at trial. However, when a wrong kind of petition is filed by the injured worker, it got dismissed. Issues that can be raised in a Petition for Reconsideration are:-

• the decision is fraudulent
• the judge didn’t have the right/power to make the decision
• the conclusions are not supported by the evidence
• the evidence doesn’t justify the decision
• due to any new evidence

Gathering the medical evidence:-

Once the appeal has been raised it is important to be prepared for everything by gathering the proofs and evidence and documentation as much as possible to dispute the reason given for compensation denial. No doubt the process of appeal varies by state, but it generally involves a hearing before the administrative law judge. The hearing can be made either through the state workers' compensation board or the labor department. This hearing gives the opportunity to the worker to show the evidence and proof. The potential evidence can also include medical records, injury photographs, test results, as well as timecards, and other proof that shows that why the compensation denial is in error.

Speak to an attorney:-

When a workers’ compensation claim got denied, it’s better to speak with a work accident attorney who can guide you and help you with his/her experience through the appeals process. Many attorneys help their clients understand the legal options that they have and only charge for the services when they succeed in providing them the benefits they deserve.

At the law firm of Godwin and Rubin in Van Nuys, California, we help injured workers and their families get the benefits they need and deserve after they have been injured at work.