Navigating the complexities of a workers’ compensation claim can be daunting, especially if your claim has been denied. In California, workers are entitled to compensation for medical expenses, lost wages, and rehabilitation services if they are injured on the job. However, not all claims are initially approved.

At PLBH, we specialize in assisting employees through the appeals process to secure the benefits they rightfully deserve. This blog will outline the critical legal steps you should take if your workers’ compensation claim is denied. Contact us at (800) 435-7542 for a free legal consultation.

Understanding Why Claims Are Denied

Before initiating an appeal, it’s important to understand why your claim might have been denied. Common reasons include:

  • Lack of Evidence: Insufficient medical evidence to prove the injury was work-related.
  • Missed Deadlines: Failure to report the injury or file the claim within the required timeframe.
  • Discrepancies in Your Claim: Inconsistencies in your account of the accident or injury.
  • Employer Disputes: Your employer may dispute the claim’s validity based on their account of the incident or the nature of your employment.

Step-by-Step Guide to Appealing a Denial

Step 1: Review the Denial Notice

  • Understand the Reason: Carefully read the denial notice to understand why your claim was denied.
  • Check for Errors: Look for any clerical errors or misunderstandings that could have led to the denial.

Step 2: File a Request for Reconsideration

  • Time Frame: You typically have 20 days from receiving the denial to file a Request for Reconsideration.
  • Required Documentation: Submit any additional evidence or documentation that supports your claim or clarifies any discrepancies.

Step 3: Prepare for the Hearing

  • Hearing Notification: If the reconsideration does not resolve your claim, the case will go to a hearing before a judge at the Workers’ Compensation Appeals Board (WCAB).
  • Evidence and Testimony: Gather all pertinent medical records, expert testimonies, and any other evidence that supports your case.
  • Legal Representation: Consider hiring a workers’ compensation attorney who can prepare and present your case effectively.

Step 4: Attend the Hearing

  • Presentation: During the hearing, both you and your employer will have the opportunity to present evidence, call witnesses, and make legal arguments.
  • Judge’s Decision: After the hearing, the judge will issue a decision, which can either uphold the denial or overturn it, granting you benefits.

Tips for a Successful Appeal

  • Act Quickly: Adhering to all deadlines is crucial in the appeals process.
  • Stay Organized: Keep detailed records of all medical treatments, communications regarding your case, and any interactions with your employer about your injury.
  • Seek Professional Help: An experienced workers’ compensation lawyer can provide invaluable assistance in navigating the complex appeals process.

How PLBH Can Help

At PLBH, our dedicated team of workers’ compensation attorneys understands the stress and frustration that can come with a denied claim. We are committed to advocating for your rights and working tirelessly to ensure that you receive the compensation you need to recover and move forward. With our extensive experience and thorough understanding of California workers’ compensation laws, we are well-equipped to guide you through the appeals process.

If your workers’ compensation claim has been denied and you’re unsure of the next steps, contact us at (800) 435-7542. We are here to help you review your case, explain your options, and represent you throughout the appeals process. Don’t navigate this challenging time alone; let PLBH help you secure the benefits you deserve.