If you were hurt at work and filed a workers’ compensation claim, you might think you are all set. You are getting free medical care for your injury and receiving disability checks while you are unable to work.
While workers’ compensation insurance companies have 90 days from the date they received a medical report concerning your injury to review the claim and decide whether to accept it. Although they must provide you benefits in the meantime, they could deny your claim after their review.
If you received a denial of a claim you filed after a work-related injury, you could contest the decision with the help of an experienced attorney. Consulting a San Diego Workers’ compensation denial lawyer before you appeal the decision on your own is a wise step.
A workers’ compensation insurer might deny a claim for various reasons. Every case is unique, but many claim denials are due to an insurance company determining that an injury:
If a claimant did not receive medical attention promptly, the insurer might assume that the injury was not distressing enough or did not cause enough inconvenience for the worker to seek medical attention. A failure to get medical help also could lead an insurer to speculate that the claimant did not receive their injury at work and decided later to try to assert the condition was work-related to secure benefits.
An individual whose workers’ compensation claim was denied could discuss the matter with an experienced labor attorney in San Diego. Together they could review the reason for the denial and prepare a strategy for appealing it.
Choosing to contest a workers’ compensation denial requires an employee to file several forms. First is an Application for Adjudication of Claim, which is the official request to open a case and assign a case number. Once the case number is received, a claimant must file a Declaration of Readiness to Proceed. This form sets forth the reasons the claimant requests the hearing and allows the injured employee to seek expedited scheduling if the denial was due to allegations that their injury was not work-related.
If the reason for the denial had to do with medical issues, the claimant will need to undergo an independent medical evaluation. Importantly, if the claimant is representing themself, they may select an evaluating physician from a list of qualified providers. However, if the claimant has legal representation, the attorney and the insurance company will select a provider that is acceptable to everyone.
Depending on the issues the appeal raised, a judge might meet all the parties at a preliminary conference. The judge will examine the issues raised and try to find a solution to the dispute. If no agreement results, the judge will set a trial date where the parties each present evidence supporting their case.
When a claim denial goes to trial, both parties must file written statements outlining the issues in dispute. They must list the witnesses they will call and summarize the testimony they expect them to provide.
The hearing is usually the only opportunity the claimant will have to face a judge and present a convincing case. Accordingly, it is critical to be well-prepared. Working with a San Diego attorney with experience in workers’ compensation denial hearings could enhance the claimant’s chances of making a persuasive case.
The trial judge will hear all the testimony, review the evidence, and issue a decision. The parties usually will not receive a decision until between one and three months after the trial. If the trial judge rules against the claimant, there is an opportunity for further appeal under limited circumstances.
If you are suffering from the effects of a work-related injury, you are entitled to receive benefits under the workers’ compensation program. However, if you have been wrongfully denied those benefits, you can dispute the denial.
An experienced San Diego Workers’ compensation denial lawyer could be a major asset in these types of cases. Schedule a consultation today.
