What could cause your workers’ comp claim to be denied?

The California Division of Occupational Safety and Health prescribes strict safety standards to keep workers in all industries safe. Employers must ensure work environments are safe and inform employees of potential hazards. Furthermore, they must provide sufficient training to ensure workers can identify threats and know how to mitigate them.

The California workers’ compensation system provides benefits to cover medical bills and lost wages to employees who suffered work-related injuries. Those whose injuries caused disabilities might receive additional benefits. It is a no-fault system that pays benefits regardless of who was at fault. However, many employers will go to any length to challenge the validity of benefits claims to avoid premium increases.

Denied claims

If you do not meet the requirements for eligibility, your workers’ compensation claim may be unsuccessful. A variety of reasons may lead to denied benefits claims, and the following are most common:

• Not work-related: Your employer might claim that your injury did not occur while you were on duty. You may need additional evidence, such as a second medical examination, to justify your claim.
• Horseplay: Compensation for injuries suffered during horseplay is typically a denial.
• Injury not compensable: Your employer could claim that the type of injury is not compensable. This often happens when claims involve stress and repetitive strain injuries, although workers’ comp in California covers those injuries.
• Time limits exceeded: There are strict time limits for the filing of benefits claims. You might want to report your injury as soon as possible, and your employer must then file the claim within a specific time limit.
• No medical treatment: Workers’ compensation typically covers your medical expenses. For that reason, it is essential for you to tell your doctor if your injury is work-related and for those bills to clearly show it as a workplace injury.

These are but some of the reasons for the denial of workers’ compensation benefits. If this happens to you, a denial letter will explain the reason. This is not the end of the road, and if you disagree with the reason for the denial, you may file an appeal.

This is where the legal process could become complicated, and an attorney with significant experience in dealing with the workers’ compensation system of California might be the best person to navigate it. Bear in mind that there is also a time limit for filing an appeal. It is best to secure the services of an attorney sooner rather than later.