A denied workers’ compensation claim signals an employer or their insurance adjuster’s unwillingness to assume liability for an employee’s injury. While notice of a denied claim is a complicating factor in your pursuit of benefits, it is not always the end of the claims process, and our skilled workers’ compensation attorneys could help you understand your options.
The reason(s) for the denial are key in determining future appeal options to recover workers’ compensation benefits. Our Santa Ana workers’ compensation denial lawyers at Silberman & Lam could help you after receiving a denial notice for your claim and get you to the next step in your case.
After submitting a claim form, the employer’s claim adjuster has 90 days to accept or deny the workers’ compensation claim. If the adjuster does not deny the claim within this period, the Division of Workers’ Compensation and Labor Code Section 5402 assumes the claim was accepted.
The adjuster should provide written notice of a denied workers’ compensation claim in Santa Ana, and a skilled lawyer could investigate the details surrounding the rejection. Keep records of submitted claims and notices to verify any issues with the timeliness of a denied claim and subsequent appeals. An injured employee or their attorney could contact the claim adjuster during the 90-day window to obtain an update on the status of the claim.
California requires employers to insure and compensate employees for injuries that occur in the workplace or in the course of their employment. An adjuster may deny a workers’ compensation claim if they believe it does not qualify for coverage based on the conditions of Labor Code Section 3600, which includes the following issues:
Aside from doubts about industrial causation, a claim adjuster could also deny a workers’ compensation claim because of procedural issues. Even if the adjuster accepts the claim, they may deny certain requests for benefits as not necessary or outside the scope of coverage. This disagreement could exist over the requested medical care, the proper rate for temporary disability payments, or the severity of permanent disability.
An injured employee can escalate disagreements with their denied Santa Ana workers’ compensation claim through the several appeal processes in California with the help of a lawyer. The first of these appeal options is to have an administrative judge hear the facts and medical evidence of the claim to decide on coverage and award benefits.
If unsuccessful, an employee can seek further review from the workers’ compensation appeals board and the California Court of Appeals. The initial appeals have a 20-day filing deadline, while an appeal to the California Court of Appeals or Supreme Court must occur within 45 days of the most recent decision.
Denied coverage for a workplace injury can lead to complex legal disputes that may benefit from the help of a Santa Ana workers’ compensation denial lawyer. Our attorneys could provide valuable representation and advice during this process to maximize available benefits for your medical and financial recovery.
We could evaluate the basis for the denied claim and determine whether you could appeal or settle with your employer during a consultation meeting. Contact us to schedule one today.
