Suffering an injury while on the job can leave you financially struggling. Most people cannot pay their medical expenses and keep up with their bills while they are out of work.
The purpose of workers’ compensation benefits is to provide you with compensation for these and other expenses while you heal from your injury. You count on this compensation to stay afloat until you can get back to work, which is why learning your workers’ compensation claim was denied can be devastating.
Missing deadlines or not seeking medical treatment
There are some common reasons workers’ compensation claims in California are denied. One is missing deadlines.
Deadlines are an extremely important part of the workers’ compensation process. You must report the injury to your employer and file your claim within certain deadlines. If you miss any deadline, your claim could be denied even if it was otherwise valid.
Your claim could also be denied because you did not seek medical treatment in time. The insurance company might believe you are filing a false claim if you waited too long to see a doctor. You should see a qualified workers’ compensation doctor even if you do not believe your injury requires treatment.
Pre-existing conditions
Sometimes claims are denied because the insurance company believes that your injury was caused by a pre-existing condition that is unrelated to your job. You could be denied even if you had a legitimate work-related injury, but it was partially caused by a previous injury.
Other common reasons for denial include evidence that your own negligence or misconduct caused the injury or the cause of the injury being undetermined. Yes, if there is not enough evidence to show the specific cause of the injury one way or another, your claim could be denied.
You can appeal a denial of workers’ compensation benefits, but you must provide evidence showing why your benefits should be granted. When you receive notice of your denial, learn the exact reason for the denial so you know what steps to take next.