Workers’ compensation benefits in Santa Ana will cover your medical bills and lost wages if you sustain an injury while working. However, the approval of workers’ compensation claims isn’t guaranteed, resulting in numerous injured workers facing uncertainty about their future actions.
That said, a denied workers’ compensation claim does not mean all hope is lost because you can follow a structured process to challenge the decision. The Santa Ana workers’ compensation attorneys at the Law Offices of Benjamin Arsenian are ready to help you file your appeal so you can receive the compensation you deserve. Below, we discuss the typical reasons for claim denials and explain the appeals process along with the benefits of hiring a knowledgeable workers’ compensation attorney to guide you through this complicated system.
Why Are Workers’ Compensation Claims Denied?
Before starting the appeals process, it is important to know the reasons behind claim denials. Some of the most common reasons include:
- California law requires injured workers to notify their employers about their injuries within a 30-day period. When you don’t follow these guidelines, your claim can be rejected.
- Workers’ compensation claims must be submitted within one year following an injury. Missing the claim filing deadline will result in automatic denial of your claim.
- Your employer or their insurance company might claim that your injury did not happen during work activities or while performing your job responsibilities.
- When your claim lacks sufficient medical documentation, insurance companies might reject it by claiming your injury does not qualify for workers’ compensation benefits.
- Insurance companies frequently deny workers’ compensation claims by claiming that the injuries claimed resulted from pre-existing conditions instead of workplace accidents.
- If your employer questions the legitimacy of your claim, then the insurance company might agree with your employer and reject your benefits.
- When your employer claims that you were intoxicated with drugs or alcohol when you got injured, your workers’ compensation claim can be rejected.
How to Appeal a Workers’ Compensation Claim Denial
You retain the right to contest the denial of your workers’ compensation claim through an appeals process. Here’s how the process works in California:
Step 1: Review the Denial Letter
The insurance company will send you a letter explaining why your claim was denied when they decide not to approve it. This letter is essential because it dictates every action you need to take during the appeals procedure.
Step 2: File an Application for Adjudication of Claim with the California Workers’ Compensation Appeals Board
The appeals process starts when you submit an Application for Adjudication of Claim to the California Workers’ Compensation Appeals Board (WCAB). Filing this application with WCAB starts your case there while serving as a required step to request a hearing.
Step 3: Request a Mandatory Settlement Conference (MSC)
After you file your application, you can request a Mandatory Settlement Conference (MSC). During the MSC, you meet with your employer’s insurance representative and a judge to present your case before attempting to reach a resolution.
Step 4: Prepare for Trial if Settlement Discussions Fail
A trial before a workers’ compensation judge will be scheduled if no settlement occurs during the MSC. During the trial proceedings, your attorney and you have the opportunity to present medical documentation, testimonies from witnesses, and expert opinions before the judge. After reviewing the evidence presented during the trial, the judge will decide whether you qualify for benefits.
Step 5: If the Judge Rules Against You, You Can Appeal to the Workers’ Compensation Appeals Board
The WCAB offers an appeal option if the judge decides in favor of the opposition. You begin the appeal process by filing a Petition for Reconsideration, which requests that the WCAB review the judge’s decision.
Step 6: Appeal to the California Court of Appeal if the Workers’ Compensation Appeals Board Denies Your Petition
If the WCAB denies your petition, you maintain the right to take your case to the California Court of Appeal. Note that the process of appealing to the California Court of Appeal demands detailed legal arguments supported by substantial evidence.
Step 7: Appeal to the California Supreme Court for Review
The final step in the appeals process is submitting a petition to the California Supreme Court. The California Supreme Court limits its case hearings to major legal questions instead of individual claims.
Our Santa Ana Workers’ Compensation Lawyers Provide Essential Assistance
Navigating a workers’ compensation appeal can be overwhelming, especially when dealing with an injury. Accordingly, our experienced Santa Ana workers’ compensation attorneys can make a significant difference in your case by:
- Filing paperwork correctly and adhering to deadlines is essential because missing a deadline or filing forms incorrectly will jeopardize your appeal. Our team will manage all necessary paperwork while ensuring legal compliance with state regulations.
- Our Santa Ana workers’ compensation attorneys will collaborate with medical experts to acquire comprehensive records and expert testimony that will strengthen your workers’ compensation claim.
- Insurance adjusters commonly attempt to lower compensation payments during negotiations. Your lawyer will represent you during negotiations to obtain the highest possible benefits from your claim.
- When your case goes to trial, having a skilled workers’ compensation attorney who presents evidence and questions witnesses can enhance your likelihood of a successful outcome.
- Our Santa Ana workers’ compensation lawyers can help you appeal your denied claim to the WCAB, Court of Appeal, or California Supreme Court to ensure your rights are upheld.
- An attorney can initiate legal measures to protect your rights if your employer retaliates against you after you file a claim.
Seek Guidance From Our Skilled Santa Ana Workers’ Compensation Lawyers Today
Although a workers’ compensation claim denial can be disheartening, you still have options to continue your fight for benefits. The appeals process gives claimants several chances to secure the benefits to which they are entitled. Learning the reasons behind claim denials and following proper legal procedures will help improve your odds of winning.
The professionalism and experience of the skilled Santa Ana workers’ compensation attorneys at the Law Offices of Benjamin Arsenian help to ensure that your case receives efficient handling. Immediately seek guidance from a qualified attorney if your claim has been denied to initiate the appeals process and safeguard your rights. Contact our office today.