Imagine showing up to work on the job site in downtown San Diego. It’s Friday and you are looking forward to a relaxing weekend filled with football, barbeque and family time. Unfortunately, things did not go according to plan. While you were at work, there was an accident and now you have to spend the weekend in the hospital.
You know that the cost for the ambulance ride and your hospital stay is going to be outrageous, but you are not worried because your employer’s workers’ compensation insurance should cover the cost. In addition, you should also receive benefits for the time you have to take off of work. Everything will be fine. But, what if it isn’t? What if your employer or the insurer deny your workers’ compensation claim? If you are facing a workers’ compensation denial, read below to find out what steps you should take.
Reasons for a denial
If you receive a denial for workers’ comp benefits, the first step is finding out why. The denial letter that the insurance company sent should explain the reason. In some cases, a denial is simply a clerical error. In other cases, the denial could be because you are not eligible for benefits or perhaps your employer claims you were acting recklessly when the injury occurred. Other common reasons for a denial include filing a claim beyond the time limit or not reporting the injury to your employer in time. Also, your boss could be disputing the claim or there is not enough evidence that the injury is work-related.
Filing an appeal
The appeals process for fighting back against a workers’ compensation denial can be extremely complicated and time-consuming. If you plan on filing an appeal, your denial letter should list a deadline for you to do so. Once you submit your appeal, you will probably have to attend a hearing with an administrative law judge. Keep in mind that this may be just the first step in the process.
When you come for your initial hearing, be sure to bring any evidence, such as medical records and witness statements, that attest to your claim. Your goal is to prove that your injury occurred while you were on the job and did not result from your own misconduct.
If you have suffered a workplace injury and you are facing a denial of workers’ compensation benefits, remember that you still have options. You can fight back against a denial by following California’s workers’ comp appeal procedures and come out with the benefits that you deserve.