How To Handle Denied Claims

When you report your work injury to your employer, a claim starts for your injury with the appropriate workers compensation insurance agency.   After your claim is started, the insurance adjuster who is assigned to your case conducts an investigation.   The insurance adjuster tries to find out if your injury occurred on the job, and during this stage, many workers compensation claims are initially denied.

WHAT HAPPENS IF MY WORKERS COMPENSATION CLAIM IS DENIED?

If your workers compensation claim is denied, you will not receive any workers compensation benefits at first.    The adjuster will not allow you to get medical treatment within the insurance company’s Medical Provider Network (“MPN”).   Also, the insurance company will not send you any disability payments.

In the event your claim gets denied, our law office will refer you for medical treatment.   The doctors that we send you to will bill the workers compensation insurance company at the end of the case.   They will not ask you for payment.    Also, if the doctor thinks you are not able to work, they can help you apply for disability benefits from the Employment Development Department (“EDD”).   You may receive up to one year of EDD benefits.

IS MY DENIED WORKERS COMPENSATION CLAIM WORTH ANY MONEY?

It is normal for a workers compensation claim to get denied.   When that happens, our office files an Application for Adjudication with a local Workers Compensation Appeals Board (“WCAB”).   If your case is denied, we can get a neutral doctor opinion under Labor Code 4060.  The doctor can help to determine if you sustained an injury on the job.

Our office has settled denied workers compensation claims for over $100,000.  Although the denial is a decision by the insurance company, when we go to court, the judge decides if your case has value.   Also, the defendant might choose to settle the case before going before a judge.

Our office has a 99% success rate in winning denied claims.

WHAT HAPPENS AT A WORKERS COMPENSATION HEARING?

When the parties have a disagreement, they go to court to work it out.  There are several types of hearings.  The first one is a status conference.  This is where the attorneys try to work out a minor issue of the case such as getting a hold of the other side.

The second type of hearing is a Mandatory Settlement Conference.  When the case is ready to settle, the parties appear at this hearing if they cant come to a settlement agreement.

The third type of hearing is a priority conference.   This hearing is set when the insurance company is denying that you were injured on the job.

If the issues can’t be resolved at one of the hearings above, the case gets set for trial.   At trial, the parties submit their trial documents and witnesses so that the judge can make a decision on the issues. At all the hearings, except for trial, the injured worker waits in the lobby at the WCAB.  The attorneys go in to talk to the judge and come back to their clients with updates.  Injured workers are not required to do anything at hearings except attend the hearing. Trial is very rare.  If the case goes to trial, you might have to give short testimony in front of the judge about your injury.  There is no jury in a workers compensation trial.

HAVE QUESTIONS ABOUT DENIED WORKERS COMPENSATION CLAIMS?

If you have any questions, our experienced workers compensation attorney can discuss your claim with you in a free consultation.   We will look forward to answering your questions about the difficult workers compensation process.