Sacramento Union Worker Injuries Lawyer
If you suffered a work-related injury or illness, you are entitled to Workers’ Compensation benefits, which generally cover medical expenses associated with the injury or illness, lost wages, vocational rehabilitation, disability benefits, and a death benefit for your surviving family members if you pass away. However, it is not uncommon for insurance companies to deny legitimate claims, which can be financially devastating, particularly if your injury is severe and you require ongoing medical care.
If you have a general understanding of some of the common reasons why Workers’ Compensation claims are denied, you can take proactive steps to avoid these issues and ensure that your claim is approved. The Sacramento Workers’ Compensation Lawyers at Walters & Zinn, Attorneys at Law, will assist you with the claims process and pursue the maximum benefits to which you are entitled.
How Do I Know if I Am Eligible for Workers’ Compensation Benefits?
In order to be eligible for Workers’ Compensation benefits in California, you must meet the following requirements:
- Your employer is required to carry Workers’ Compensation insurance.
- You must be an employee. Freelancers, consultants, and other independent contractors are not eligible for Workers’ Compensation benefits. In most cases, volunteers are not covered by Workers’ Compensation, although there are exceptions to this rule. For example, volunteer firefighters are eligible for Workers’ Compensation benefits in California.
- The injury must be work-related. The injury must have occurred while you were performing a task on behalf of, and for the benefit of, our employer. If your injury occurred while you were on a lunch break off the premises or on your way home from work, this would not be considered a work-related injury.
How Do I Apply for Workers’ Compensation Benefits in Sacramento?
It is important to act quickly after a workplace injury and take immediate steps to initiate the claims process. There are a number of steps involved in applying for benefits, including the following:
- Report the injury. You must report the injury to your employer as soon as possible, but no later than 30 days after the injury occurred. The longer you wait to report the injury, the more likely it is that the insurance company will deny the claim. Make sure that you notify your employer in writing so that there is a paper trail.
- Seek immediate medical treatment. This is critical to a successful claim. Provide a detailed explanation about the injury and how it happened. Do not downplay the severity of the injury; this could negatively impact the outcome of your claim.
- File an official claim. Your employer must provide you with a DWC-1 form within one working day of reporting the injury. After filling out the form completely, keep a copy for your records and submit it to your employer.
- Insurance company conducts an investigation. The insurance company has 90 days to review your claim and respond with a decision.
Manage the outcome of the claim. If your claim is approved, you will start to receive benefits. If it is denied, you have the option of appealing the decision.
What Are the Most Common Reasons Workers’ Compensation Claims Are Denied?
Insurance companies deny Workers’ Compensation claims for a number of reasons. You can prevent this from happening if you avoid common mistakes that can have a negative impact on your claim. The following are examples of common reasons why insurance companies may deny a Workers’ Compensation claim:
- The injury is not work-related. If the insurance company suspects that the injury was not directly work-related, they may deny the claim. For example, if you were injured in a car accident on your way home from work, or the injury was related to a preexisting condition, your claim may be denied.
- Your employer disputes the claim. If your employer argues that the injury was not work-related or that it happened outside of the workplace, the insurance company may deny the claim.
- You filed the claim late. You must file a Workers’ Compensation claim within 30 days of the injury. If the claim is filed after 30 days, your claim will likely be denied, and you will be unable to recover benefits.
- The paperwork is incomplete or inaccurate. If you did not fill out the DWC-1 form completely, or if any information is incorrect, this can result in a claim denial. This can include incomplete medical records, inconsistent statements about the injury, or a failure to provide documents that have been requested.
- You failed to seek medical attention. If you did not get medical attention for your injuries, or you delayed getting treated, the insurance company may argue that your injuries must not be very serious if you did not find it necessary to seek treatment right away.
- You were intoxicated at the time of the injury. If you were under the influence of drugs or alcohol when you suffered the injury, the insurance company may deny your claim, even if it occurred at the workplace. A denial may be overturned if you can prove that the intoxication was not the cause of the injury.
Can I Appeal a Workers’ Compensation Claim That Has Been Denied?
If you were notified that your Workers’ Compensation claim has been denied, you may be able to appeal the decision. Make sure that you read through the letter provided by the insurance company, as this will likely include a reason for the denial. Once you understand why your claim was denied, you can determine the best course of action moving forward. The Sacramento Workers’ Compensation lawyers will discuss the details of your case, including why your claim was denied, and recommend an effective strategy for appealing the decision. The following are important steps to take when appealing a denied claim:
- Request for Reconsideration. After reviewing the reason for the denial with your Workers’ Compensation lawyer, you can file a Request for Reconsideration with the Workers’ Compensation Appeals Board (WCAB). You will need to include a detailed explanation for why you believe the denial is incorrect, new medical documentation or supporting witness statements, and a list of reasons why your claims should be reconsidered.
- File a Petition for Reconsideration. If your Request for Reconsideration is denied, you can file a Petition for Reconsideration, which is a formal request for the WCAB to review the decision made by the insurance company. Your petition should include the following information:
- Reasons for the appeal
- Legal basis for your case. Make sure that you reference the specific California Workers’ Compensation laws that support your claim.
- Supporting evidence, including new or previously overlooked evidence that supports your claim.
A judge will review the petition and make a decision based on the information presented. If the judge rules in your favor, they may reverse the denial, and you will be awarded compensation.
- WCAB Hearing. If the judge denies your Petition for Reconsideration, you may proceed with a formal hearing with the WCAB, where both sides present their case to a judge. After hearing evidence, witness statements, and any other facts presented, the judge will issue a decision.
- Decision and Appeals. If the judge rules in your favor, you will start to receive Workers’ Compensation benefits. However, if the outcome is not what you hoped for, you can continue with the appeals process. Your Workers’ Compensation lawyer will discuss your options and recommend the best legal course of action that will have the best possible outcome.
Sacramento Workers’ Compensation Lawyers at Walters & Zinn, Attorneys at Law, Advise Clients Whose Workers’ Compensation Claims Have Been Denied
If you were injured on the job and your Workers’ Compensation claim has been denied, it is highly recommended that you contact the Sacramento Workers’ Compensation lawyers at Walters & Zinn, Attorneys at Law. We will review your claim and the reason for the denial, and we will recommend the most effective strategy to recover the benefits to which you are entitled. To schedule a free consultation, call 916-610-4706 or contact us online. Our offices are located in Folsom and Fairfield, California, where we serve clients in the surrounding areas.
