Knowing that you could apply for workers’ compensation benefits if you are injured or ill on the job gives you peace of mind. California requires all employers to carry this insurance on full-time and part-time employees. If you become incapacitated because of a workplace injury or illness, you could expect to collect temporary or permanent disability payments.
A problem arises when an insurance carrier denies your benefits. You may have received a denial and read it with disbelief. Contact a seasoned workers’ compensation attorney if you were denied benefits to help pay medical bills and lost wages after a workplace injury. A Fresno workers’ compensation denial lawyer is ready to fight for your rights.
Employers do not distribute workers’ compensation benefits automatically. Injured workers must apply for them and provide corroborating evidence. Many people find this process complicated and frustrating, especially when an employer denies a claim. Common reasons insurance companies deny claims include:
Workers who were denied benefits could believe there is no other option and become discouraged. A competent lawyer in Fresno could investigate why a workers’ compensation claim was denied and appeal that rejection.
Claims adjusters or administrators decide whether an injured worker should be granted benefits. State law requires adjusters to be certified and complete thirty hours of continuing education every two years. Their job is to get injured workers their benefits promptly and avoid litigation. State laws govern how insurance companies and employers who have self-insured against workers’ compensation liability administer benefits to individuals.
If an adjustor denies a claim, then a simple fix, such as submitting missing paperwork, may resolve the issue. However, in most cases it will not and you will need to proceed to formally appeal the denial. Contact a Fresno injury attorney to begin the process of correcting or appealing a denied workers’ compensation claim.
Injured employees could appeal a denial of benefits by filing an Application for Adjudication of Claim in the county where their employer is based. A qualified medical evaluator (QME) will examine an individual’s records to settle a denial or disagreement with a treatment plan.
Qualified medical evaluators (QMEs) are licensed physicians certified by the Division of Workers’ Compensation in their respective fields, such as orthopedics, psychiatry, or cardiac specialists. The certification involves special training to provide evaluation services in workers’ compensation cases. After treatment by a QME, an injured worker will file a Declaration of Readiness to Proceed, which requests a court hearing before a workers’ compensation judge.
A workers’ compensation judge will preside over a mandatory settlement conference with the adjuster and an injured employee’s legal representative. If the parties do not resolve the denial, the judge schedules a trial before another judge, who will issue a ruling after testimony is taken and exhibits have been submitted. A skilled lawyer in Fresno could guide an individual through the workers’ compensation appeal process after an initial denial.
You are entitled to benefits to help you pay for medical care and lost wages if you are hurt or become ill from a job-related source. You may be eligible for permanent disability and retraining in some instances. If you are injured and your benefits are denied, you may suddenly find yourself unable to take care of your family.
If this has happened to you, call us. Our multi-lingual professionals could explain the next steps after an adjustor denies your benefits. A Fresno workers’ compensation denial lawyer could determine what might have been missing from your application or aggressively appeal a denial. Call our team today to discuss your options.