California Workers’ Compensation Claim Denied?

California Workers’ Compensation Claim Denied?

When you are too injured to work, having your workers’ compensation claim denied can feel like the end of the world. Even though the workers’ comp system was developed to provide employees injured on the job with benefits, many claims are groundlessly denied or benefits delayed for no reason.  However, you have the right to appeal.  At Cramer & Martinez, LLP , our attorneys bring over 50 years of combined legal experience to ensuring that qualified workers get the compensation they deserve. Contact us for exceptional legal representation and outstanding personal support through the entire claims appeal process.

For more than 20 years, Cramer & Martinez, LLP has successfully achieved their clients’ workers’ comp goals. We provide compassionate and effective guidance through the entire legal process and help San  Martin, Morgan Hill, Hollister and Gilroy, CA employees prevail against employer defenses and challenges to claims.

What to do once benefits are denied

Thousands of workers’ comp claims are rejected every year. Was your workers’ comp claim denied? To challenge the insurance company’s decision, you must file an Application for Adjudication of Claim with the California Division of Workers’ Compensation (DWC) within one year of the date of your injury. The DWC then sends you a Notice of Confirmation with your case number.  Next, you file a Declaration of Readiness to Proceed, a request for mandatory settlement conference (MSC) before a judge. At this hearing, your attorney and the claims adjuster each present their side of the story. If you cannot reach a settlement at the MSC, your attorney prepares documents outlining the dispute, identifying what you plan to present at the trial and the names of any witnesses. A date is then set for a trial before another judge. Usually within 30 to 90 days after the trial, the judge issues a written decision.  Both parties have the right to appeal the judge’s decision to the Workers’ Compensation Appeals Board (WCAB) by filing a Petition for Reconsideration within 20 days after receiving the decision.

Through the course of the appeals process, your attorney works to disprove the reasons the insurance company denied your claim. The most common causes cited for rejecting claims include:

  • The injury did not happen at work
  • The injury was caused by a pre-existing condition
  • The claim was not filed within the statute of limitations
  • The workers acted willfully or willfully disobeyed a safety regulation
  • A medical expert stated you were not disabled by your injury
  • The worker was intoxicated and that caused the accident

The attorneys at Cramer & Martinez, LLP bring the strongest possible advocacy to workers’ compensation appeals. Their attorneys gather documentary evidence and witnesses to refute the insurance company. They may retain medical experts and ask you to submit to an independent medical review.

What to do when your benefits are ending

Have your workers’ compensation benefits ended? If you have been the victim of a workplace accident, you deserve to reach maximum medical improvement (MMI) before returning to work. However, it is possible that your benefits will expire before you reach that point. In that case, you can have a medical evaluation to see if you qualify for permanent disability benefits. The doctor determines your condition has become permanent and stationary (P & S) and sends a report to the claims administrator and the DWC’s Disability Evaluation Unit (DEU). You are assigned a Permanent Disability Rating, which determines the amount of benefits you receive going forward. If you disagree with the doctor’s finding, you can request an evaluation by a qualified medical examiner. Or, if you have an attorney, the examining doctor can be one agreed upon by you and the claims administrator. The DEU makes the final determination on extending your benefits.  There are strict time limits for taking all the actions related to the extension of your benefits. At every step of the process, the dedicated workers’ compensation attorneys at Cramer & Martinez, LLP work to protect your rights.

California Workers Comp Benefits attorney serving San Martin, Morgan Hill, Hollister and Gilroy

If your workers’ compensation claim has been denied or your benefits have ended before you reach maximum medical improvement, it is critical to take timely and proper action. The experienced attorneys at Cramer & Martinez, LLP can evaluate your claim and develop a comprehensive and compelling appeal.  Call (408) 848-1113 to schedule a free initial consultation or contact us online. We also provide legal services in Spanish.

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