My Claim Was Denied, Now What?
It can be the worst feeling in the world: You got hurt at work, made sure to dot the I’s and cross the t’s when you filed your DWC-1 form, then took some much needed time to recover, only to be turned down by the insurance company. Receiving notice that your claim was denied — when your injury happened at work and you know the pain is real — can be frustrating, disheartening, or downright terrifying. Thankfully this denial letter isn’t the end of the road.
Keep Treating Your Injuries: Medical bills can be difficult to keep up with without the aid of workers’ compensation, but it’s important that you do everything you can to address your injuries. This means sticking to prescribed medication regimens and going to follow up visits with doctors and therapists. Failing to do so can hurt you in two ways: Your injury may get worse, and you are giving the insurance agency more ammunition to poke holes in your claim.
Who Can You Call? Don’t let a denied claim cast doubt on your injuries. Insurance companies deny valid claims all the time, knowing that most workers won’t fight back. But an experienced California workers’ compensation attorney can guide you through the complex legal process to force the insurers to accept your right to compensation.
Workers’ Compensation Appeals Board (WCAB), Qualified Medical Examiner and Agreed Medical Examiner The next steps illustrate the need for an experienced lawyer. Depending on the reasons your claim was denied, different legal approaches will be required. If the insurance company disputed some crucial fact to your case, such as whether you’re an employee, you’ll need to have a hearing before the Workers’ Compensation Appeals Board (WCAB). If the cause of your injury is what’s in question, you will need to see a qualified medical evaluator (QME) or an agreed medical examiner (AME) evaluate your claim.