San Jose Workers’ Compensation Appeals Attorneys

Helping You Appeal Workers’ Comp Denials

Workers’ compensation is designed to help you stay financially stable as you recover from a work-related accident. However, workers’ comp benefits are not guaranteed. There are reasons why workers’ comp claims can be denied, and those reasons are used countless times each year to deny claims across the country.

If you were injured in a workplace accident in San Jose, then please know that Pacific Workers', The Lawyers for Injured Workers and our workers’ comp denial lawyers can help you explore your options. With more than 130 years of collective legal experience, we are prepared to navigate your case from start to finish. Through an appeal to the Workers’ Compensation Appeals Board (WCAB) and an administrative law judge (ALJ), we might be able to recover the benefits owed to you. If necessary, we can pursue a lawsuit if the claim was denied and fight for a settlement in your name.

Please call (888) 740-6434 to contact our San Jose workers’ compensation office now if your claim was denied for any reason.

When to Appeal a Workers’ Comp Claim Denial

Don’t assume that a workers’ compensation claim denial means that you can’t get workers’ comp benefits. No matter how straightforward or assertive the denial notification might have sounded, there could be a real chance to appeal the denial and get the benefits that you need. In many cases, denials happen due to a clerical error, like a simple filing mistake, so correcting the issue could be simpler than you think. It would be a shame to lose the benefits owed to you just because you don’t want to explore your legal options.

At our firm, we believe that anyone who has had their workers’ compensation claim denied can benefit from at least talking to our appellate attorneys. You will never know how much your life could be changed for the better if you take the denial letter at face value. With our legal counsel and representation, you will be ready to file the appeal, attend the appellate hearing, speak with an administrative law judge to prove your argument, and much more.

Why Workers’ Comp Claims are Denied

The start of the workers’ comp appellate process is to understand why your claim was denied. In the denial notification that you received, the reason should be explained clearly. If it is not, then it could constitute bad faith insurance, which is a different legal conflict altogether.

A few common grounds for workers’ compensation claim denials include:

• No applicable workers’ compensation coverage
• No medical treatment was necessary for the injury
• No wages were lost due to the injury or recovery process
• Injury was not reported in time
• Claim was not filed in time
• Claim was filed with errors
• Credible accusations of intentional employee misconduct

Based on the reason for the workers’ comp claim denial, our team can start to build the argument to present during the appeal. If we think that an appeal is not the right course of action, we will let you know. Honesty and transparency are two of our foundational principles at Pacific Workers', The Lawyers for Injured Workers.

Basic Steps to File an Appeal

What does the workers’ compensation claim appellate process look like in California? You don’t need to worry about the details yourself, not when you have our San Jose workers’ comp appeals lawyers acting on your behalf. We are ready to help move your case forward in all circumstances.

Every appellate process is unique, but most will include these basic steps:

• Filing an Adjudication of Claim with the local Department of Workers’ Compensation office.
• Requesting a hearing before the WCAB.
• Attending a mandatory settlement conference (MSC) to see if the issue can be solved through a settlement that doesn’t require a trial.
• Preparing for trial if a settlement or the initial appellate hearing is not successful.
• Attending the trial, presenting evidence and arguments, and awaiting the judge’s decision within 30 to 90 days.
• Filing a petition for reconsideration if the judge’s decision was lawfully erroneous.

What Happens If Your Appeal is Approved or Denied?

In California, the outcome of a workers' compensation appeal can have significant consequences for injured workers. Let's discuss what happens if your workers' compensation appeal is either denied or approved:

• Denied Appeal: If your workers' compensation appeal is denied, it means that you won't receive the benefits you were seeking through the appeal process. Here's what typically occurs:
  • No Additional Benefits: You won't receive the additional benefits you were appealing for, such as medical treatment, temporary disability benefits, permanent disability benefits, or vocational rehabilitation services.
  • Exploring Further Legal Options: If you believe the denial was unjust or if there were errors in the appeal process, you may choose to pursue further legal action. This could involve filing a new appeal or, in some cases, seeking a review from the Workers' Compensation Appeals Board (WCAB).
  • Consulting an Attorney: It's advisable to consult with a workers' compensation attorney who can assess the denial, the reasons behind it, and advise you on the best course of action. An attorney can help you determine if there are grounds for further appeals or legal challenges.
• Approved Appeal: If your workers' compensation appeal is approved, it means that you've successfully demonstrated that you are entitled to the benefits you were seeking. Here's what typically happens in this case:
  • Receiving Benefits: You will receive the workers' compensation benefits you were appealing for, which could include medical treatment, temporary disability benefits, permanent disability benefits, vocational rehabilitation, or other appropriate benefits.
  • Continued Care and Support: If your medical condition requires ongoing treatment or support, you will continue to receive these benefits as long as it's deemed necessary to treat your work-related injury or illness.
  • Monitoring and Reporting: You may need to adhere to specific guidelines, reporting requirements, and medical evaluations to ensure that you are receiving the necessary care and support.
  • Return to Work or Vocational Rehabilitation: If you're able to return to work, you'll receive assistance in reentering the workforce. If you're unable to return to your previous occupation, vocational rehabilitation services may be provided to help you develop new job skills or find suitable alternative employment.
  • Protection from Retaliation: It's important to note that being granted workers' compensation benefits should protect you from any retaliation or discrimination by your employer related to your claim. If you face any such issues, you may have additional legal rights and remedies.

In both cases, it's essential to consult with an experienced workers' compensation attorney to navigate the complex California workers' compensation system effectively. They can help you understand your options, ensure that your rights are protected, and guide you through the appeals process, whether it's a denial or an approval.

Call to Arrange a Free Consultation

If you've had your workers' compensation benefits denied in San Jose, turning to us at Pacific Workers', The Lawyers for Injured Workers can make a significant difference in your situation. We have a team of experienced workers' compensation attorneys who are well-versed in the complex laws and regulations governing workers' compensation in California.

Here's how we can help you appeal the denial of your benefits:

• Expertise and Legal Knowledge: We understand the intricacies of California's workers' compensation system. Our team will analyze your case to determine the exact reasons for the denial and identify the best course of action.
• Thorough Investigation: We will conduct a comprehensive investigation, gathering all necessary evidence, including medical records, accident reports, witness statements, and any other relevant documentation. This ensures that we have a strong case to support your appeal.
• Filing an Appeal: We will handle all the paperwork and documentation required for filing an appeal. This process can be complex and time-consuming, but we have the experience to navigate it efficiently.
• Negotiation: Our skilled attorneys can engage in negotiations with the insurance company to attempt to resolve your case without going to court. We will strive to secure the maximum compensation available to you.
• Legal Representation: If negotiation fails, we will provide strong legal representation for you in court. We will present your case, arguing for your rights and the compensation you deserve. We have a track record of successfully representing injured workers in court.
• Timely Updates: Throughout the entire process, we will keep you informed and provide regular updates on the status of your case. You'll always know where your case stands and what the next steps will be.
• Maximizing Benefits: Our goal is to ensure you receive the full extent of benefits you are entitled to under the law. We'll fight to make sure your medical bills, lost wages, and any other related costs are covered.
• Protection from Retaliation: If you're worried about potential retaliation from your employer due to the workers' compensation claim, we can provide guidance and take appropriate legal action to protect your rights.
• Appeals Process Guidance: We'll guide you through the appeals process, explaining each step and ensuring you understand your rights and options.
• No Fees Unless We Win: At Pacific Workers', The Lawyers for Injured Workers, we work on a contingency basis, meaning you won't have to pay legal fees unless we succeed in securing your benefits.

Our firm is here to help you make the most of your workers’ compensation appeal in San Jose. No matter what industry you work in or how you were injured at work, we can help you. Our experience and resources are extensive enough to handle any case with confidence, so put yours in trusted hands today.

For a FREE consultation, just dial (888) 740-6434.