Learning that your workers’ compensation claim has been denied can be devastating, but it does not mean you are out of options. If the insurance company is refusing to pay you benefits, you can fight back with an appeal, and an experienced workers’ comp attorney from Oktanyan Law Firm, APC could help.
Our Pasadena workers’ compensation appeals lawyer could determine why your initial claim was unsuccessful and help you build a stronger case. We could guide you through the appeals process, working tirelessly to secure your medical coverage and lost wages.
Reasons for Workers’ Compensation Claim Denials
Nearly every employer in California is legally required to provide its employees with workers’ compensation insurance coverage. This insurance pays for medical treatment if you suffer an injury at work. It also provides wage replacement benefits if you cannot work while you heal or your injury results in a permanent disability.
Workers’ comp is no-fault, so you do not have to prove that your company or anyone else is responsible for causing your injury, though you could have a negligence-based claim against a third party. You will need to show that your injury occurred while you were working and is severe enough to warrant time off from work.
Insurance may deny your claim if it does not feel you proved these two factors, as well as for other issues. Common reasons for denial include:
- You did not provide enough medical documentation
- You did not report your injury to your employer in a timely fashion (within at least 30 days of when you were hurt)
- Your claims paperwork was incorrect or incomplete
- The insurance company does not believe your injury happened at work
- The insurance company believes your injury is due to a pre-existing condition
- The insurance company alleges your injury is due to your own misconduct, such as being intoxicated while working
Insurance companies sometimes deny claims in error. Sometimes, insurers look for reasons to invalidate them to keep their payouts as low as possible. Our workers’ compensation appeals attorney in Pasadena could help you correct any mistakes and support your claim with additional evidence. Our goal is to help you secure maximum compensation, and no case is too big or too small.
When Should You File an Appeal?
You should hear from the insurance company about whether it is denying or accepting your claim within a reasonable time frame. If you do not hear anything within 90 days of filing, you can assume it has been accepted in most cases.
If you receive a denial notice, you should begin your appeal immediately because deadlines for initiating the process can be short. You should consider contacting our Pasadena workers’ comp attorney to start working on your appeal as soon as you hear about the denial. Our attorneys can also help appeal a discontinuation or reduction in your benefits.
How Do We Help With Your Appeal?
Workers’ compensation appeals can be complex, but our lawyer in Pasadena could prepare your case and represent you throughout the process.
We could:
- Review your initial claim and identify where we could strengthen it
- Obtain additional medical evidence verifying your injury and proving its severity
- Gather eyewitness statements, workplace accident reports, and other evidence to prove your injury is work-related
- Prepare and file paperwork related to your appeal
- Represent you during conferences and hearings before an Administrative Law Judge (ALJ)
- Elevate your appeal if you disagree with the ALJ’s decision
Our law firm handles general workers’ compensation claims. We also have a division focused on catastrophic claims. These claims involve spinal cord injuries, traumatic brain injuries, severe burns, and other injuries that may result in a 100 percent permanent disability rating.
Contact Our Pasadena Attorney About a Workers’ Comp Appeal
Our law firm has helped California workers recover significant compensation for work-related injuries. We know that a claim denial can be stressful and scary, but our Pasadena workers’ compensation appeals lawyer could help you fight this decision and pursue the benefits you need to heal.
At Oktanyan Law Firm, APC, Getting You Back To Your Life™ is what we do. Contact us today for a free consultation.