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Being injured on the job may leave you feeling frustrated at the mountain of paperwork needed to secure the benefits essential to recovery. When you submit a claim and it is denied, the process becomes even longer and more difficult to accept. While the process can be lengthy, there are measures you can take to make the process go more smoothly.
Workers’ compensation claims may be denied for different reasons. Here are a few of the most commonly cited reasons:
Some of these reasons may be legitimate and prevent you from receiving workers’ compensation. Other times, however, the rejection may be an error on the part of the insurance company or a misrepresentation of the facts or circumstances surrounding your claim.
If you have doubts about the compensation, benefits, or other circumstances surrounding your claim, an experienced workers’ compensation attorney in California can help you evaluate your situation and actively ensure you receive the benefits you deserve. Seek legal advice regarding a claim denial if:
Your attorney may be instrumental in helping you understand your legal options after your claim has been denied. They can also keep the adjudication process moving forward in a timely manner and represent you in legal proceedings to ensure your case is fully addressed. In workers’ compensation cases, your attorney cannot charge you directly for legal assistance. They receive payment from your workers’ compensation benefits.
In the state of California, you must file an “Application for Adjudication of Claim” to have your situation heard by a judge for further evaluation. If you believe your claim was wrongfully denied, filing this form creates a case with the local Workers’ Compensation Appeals Board. You must file the application in your resident county or in the county where you suffered the injury.
After the application has been filed and presented to the appropriate parties, you or your attorney will need to make sure you receive a notice of filing. Keep the assigned case number on hand, as you will need it for any further documentation regarding the case.
The next step to take after receiving notice is to file a “Declaration of Readiness to Proceed.” This declaration is a request for a hearing in front of a judge. You, your attorney (optional, but recommended), and your insurance administrator will sit down with a judge during this hearing and try to reach a settlement. If no agreeable settlement can be met, the judge will schedule a time for trial with another judge.
The process can become complex when an insurance company refuses to settle or if a trial renders an unsatisfactory decision. There are additional steps you can take, but everything must occur within a specific time frame. Hiring our experienced workers compensation attorneys at DiMarco | Araujo | Montevideo will provide you with the expertise you need to navigate California’s workers’ compensation laws.