Did Your Employer Deny Your Workers’ Compensation Benefits?
Our California Attorneys Are Available to Assist in Workers’ Comp Denial Cases
After a workplace accident, having your workers’ compensation claim denied can be devastating to you and your family. Even though the workers’ comp system exists to provide employees injured on the job with benefits, many claims are illogically denied or benefits delayed without reason. However, this does not have to be the end of the story. You have the right to file an appeal and fight for the benefits you deserve. However, filing a successful appeal can be difficult; therefore, you should always consult with a qualified California workers’ compensation attorneys.
At Cramer Martinez, our attorneys bring over 50 years of combined legal experience representing employees so that they can 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 has successfully worked with people who have experienced workers’ comp denials. We provide compassionate and effective guidance through the entire legal process and help San Martin, Morgan Hill, Hollister and Gilroy, CA and the surrounding city employees prevail against employer defenses and challenges to claims.
Why Did I Receive a Workers’ Compensation Denial?
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.
- A pre-existing condition caused the injury.
- The injured worker did not file within the statute of limitations.
- The worker acted willfully or willfully disobeyed a safety regulation.
- A medical professional does not see your injury as a disability.
- Substance abuse or intoxication impaired the worker, leading to the accident.
Often, employers and insurance companies wrongfully deny claims by saying that the accident was not “work-related.” However, any injury that you sustain on the premises of your workplace or while performing your job should be covered. You can usually file a claim even for injuries you sustain during breaks or in the parking lot. The only exceptions may be injuries that result from illegal activities or actions that directly violate company policy. Our California workers’ comp attorneys can help you fight to appeal a wrongful denial.
What Do I Do If My Workers’ Compensation Benefits Are Denied?
Thousands of workers’ compensation claims are rejected every year. 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 Application along with your case number.
Once you receive your number, you may then 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, then your attorney prepares documents outlining the dispute, identifying what you plan to present at the trial and the names of any witnesses. The legal team then schedules 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 “Petition for Reconsideration” within 20 days after receiving the decision.
What Can I Do When My Benefits End?
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 process is complicated, but with the assistance of an experienced attorney, you could receive the protection that you deserve.
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 then receive a Permanent Disability Rating, which determines the amount of benefits you receive going forward. If you disagree with the doctor’s findings, then you can request an evaluation by a qualified medical examiner. Otherwise, if you have an attorney, then the examining doctor can be one agreed upon by you and the claims administrator. The DEU makes the final determination on extending your benefits. However, there are strict time limits for taking all the actions related to the extension of your benefits, so it is important you begin the process as soon as possible.
If you cannot do your regular duties and the insurance company is not paying you benefits you can apply for disability payment from State Disability Insurance (SDI). However, you must apply during certain time limits or you will not qualify for this benefit. Once the insurance company accepts your claim or begins payments, you should notify SDI so they can stop benefits.
Call a CA Workers Comp Benefits Attorney Serving San Martin, Morgan Hill, Hollister, Gilroy and the surrounding cities
The attorneys at Cramer Martinez advocate for injured employees in workers’ compensation appeals. We gather documentary evidence and witnesses to refute the insurance company. Additionally, we may retain medical experts and ask you to submit to an independent medical review. If your workers’ compensation claim has been denied or your benefits have ended before you reach maximum medical improvement, then it is critical to take timely and proper action.
Our experienced attorneys will evaluate your claim and develop a comprehensive and compelling appeal. Our legal team includes Spanish speakers to assist as many people as possible. Call (408) 763-8336 to schedule a free initial consultation or contact us online.