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Ochoa & Calderon

Reasons Why Your Workers’ Compensation Claim Might Be Denied

workers comp declined or rejected

Ochoa & Calderón, Riverside Workers’ Compensation Attorneys, are dedicated to ensuring California workers receive the compensation they’re entitled to when they’ve been injured on the job. Work-related injuries can put substantial strain on your life—physically, emotionally, and financially. A denial of your workers’ compensation claim can exacerbate this stress. In this blog post, we’ll delve into common reasons why workers’ compensation claims are denied in California, helping you understand this complex process more easily.

Delay in Reporting the Injury

California law stipulates that you must report a work-related injury to your employer within 30 days. If you fail to report the injury within this timeframe, your claim could be denied. Prompt reporting is crucial, and it’s always beneficial to report in writing to establish a verifiable record of communication.

Lack of Adequate Medical Evidence

A workers’ compensation claim must be substantiated with compelling medical evidence. If the medical reports fail to demonstrate a clear link between your injury and your employment, your claim could be denied. To prevent this, follow through with all medical appointments, openly disclose all symptoms, and ensure your medical reports accurately reflect the incident and the nature of your injury.

Questions Surrounding the Work-Related Nature of the Injury

Workers’ compensation is designed to cover injuries that are directly work-related. If the insurance company concludes your injury did not occur as a result of your job duties, your claim could be denied. Hence, it’s crucial to document all the details surrounding the incident to establish a clear connection between your injury and your job.

Employer Disputes the Claim

At times, employers might dispute a claim, arguing that the injury occurred outside the workplace or that the employee is exaggerating their condition. In these situations, the counsel of a seasoned workers’ compensation attorney can prove invaluable in advocating for your rights and ensuring your side of the story is heard.

Filing a Claim After Employment Termination

If you file a claim after being laid off or terminated, insurers may be skeptical and question the claim’s legitimacy. To avoid this, report injuries promptly and definitely before any termination or layoff occurs.

Errors or Incompleteness in Claim Forms

The DWC-1 claim form required in California is detailed and demands comprehensive information. If it’s filled out incorrectly or incompletely, it could result in your claim being denied. Engaging a skilled workers’ compensation attorney can help you navigate these intricate forms correctly, ensuring your claim is fully and accurately presented.

Even if your claim has been denied, remember that this isn’t the end of the road. You have the right to appeal the decision through the California workers’ compensation system. Our team at Ochoa & Calderón is well-versed and experienced in navigating these appeal processes and can help you understand why your claim was denied, and what steps to take next.

Understanding why claims can be denied is the first step toward avoiding negative outcomes and protecting your rights as a California worker. If you’re facing challenges with your workers’ compensation claim, don’t hesitate to reach out to us for a free consultation. Let our expertise help you secure the compensation you’re entitled to, allowing you to focus on what’s most important—your recovery.

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