Workers’ Compensation Denials in San Jose
Call Our San Jose Law Firm If Your Claim was Denied
If you were hurt on the job, then you should be able to depend on workers’ compensation benefits to get you back on your feet. However, many workers’ compensation claims are denied when they are first filed. The denials can be issues for a variety of reasons, but you don’t need a variety of law firms to help with your case. Pacific Workers', The Lawyers for Injured Workers in San Jose can offer all the legal counsel and representation that you need to challenge a workers’ comp denial.
An appeal can be used to challenge the denial, and our attorneys are well-versed in all steps of a workers’ comp appeal. We are here to assess your case, uncover why it was designed, and strategize an appeal based on our findings.
Learn more today by calling us at and asking for a free case evaluation.
Why Workers’ Comp Cases are Denied
It might be tempting to assume that your workers’ compensation claim was denied for incorrect reasons. Yet there are many legitimate reasons why a claim can be denied. One of the first steps when helping with your denial is to review the denial letter to find the reasoning behind it.
Workers’ compensation claims can be denied for these reasons and more:
- Failure to file the claim on time: Failure to file a Workers' Comp claim within the strict deadlines set by California law can result in claim denial. These deadlines, known as statutes of limitations, vary depending on the type of injury or illness. It's crucial for injured workers to be aware of these timeframes and to file their claims promptly to protect their rights.
- Employer argues the accident or injury was not work-related: If an employer believes an employee's injury did not occur during or as a result of their job, they may contest the Workers' Comp claim. The burden of proof often lies with the injured worker to demonstrate a clear connection between their job duties and the injury. This can involve gathering medical records, witness statements, and other evidence to support the claim.
- Injuries are not severe enough to need medical attention or cause lost wages: Insurers may deny a Workers' Comp claim if they determine the employee's injuries are minor and did not require immediate medical treatment or result in lost wages. However, even seemingly minor injuries can have long-term consequences, and it's essential for injured workers to seek medical attention promptly. Delayed or denied treatment can worsen conditions and complicate the claims process.
- Accident was never reported to the employer: Prompt reporting of workplace accidents is crucial for initiating the Workers' Comp claims process. If an employee fails to inform their employer about the incident, it can provide grounds for the employer or insurer to deny the claim. Timely reporting allows for proper investigation, medical treatment, and wage replacement benefits.
- Faulty paperwork: If you had just one box left to check on your claim forms, you probably checked the wrong thing. For example, papers may not be adequately filled out, pages could be out of order, or you may have missed a part of the application that gets you compensation. In these cases, you can just resubmit the paperwork.
- Job description: If you have a job title that seems to fit in a different group, you may be denied. For example, a receptionist who is required to lift heavy boxes might get compensation, but a receptionist just greeting customers would not.
- Your employer does not have workers’ comp insurance: If you were hurt on the job while working for a company that has not workers’ comp insurance, you might not get compensation. The company doesn't necessarily have to be a major corporation, either—if it is an employer, it must be licensed. This includes babysitters, people you work part-time with, and any other job where you were paid by the hour. In the case of the employer not having workers’ comp insurance, you generally have one of the two following options:
- File a personal injury lawsuit against your employer
- File a workers’ comp claim with your states uninsured employer’s fund
- There is no proof that you were injured: The most common reason for a denied claim is that there is no proof of injury. If you don't have a medical report or a medical evaluation, the company could deny your claim. You may also be denied if you didn't file the claim form on time.
- The employer says you are not hurt: If the employer says you aren't hurt, you can still get compensation. This is true even if the employer claims you are just faking the injury.
If you have been denied workers' compensation, you may have a few options. You can appeal the decision to the state, raise a new claim, or take the employer to court. If you have questions about this process, you can contact our San Jose workers' compensation lawyer.
Steps to Challenge a Denied Claim
If we determine that the reason for the denial was mistaken or unjustified, then we can file an Application for Adjudication of Claim and a Declaration of Readiness to Proceed. Using these documents, we can move your case to be heard by a judge during a hearing.
In some cases, the hearing will move to a trial, too. We can prepare your case for arguments in a hearing and challenges that come up during a trial. No matter what we will fight for the denial’s reversal.
Depending on the outcome of the trial or hearing:
- Your workers’ compensation benefits could be instated and provided as they should have been from the beginning; or,
- You could be given a settlement that pays for the benefits that you require as well as other losses caused by the accident and denial.
Denials for Independent Contractors
Are you employed as an independent contractor, got hurt at work, and were unable to get workers’ compensation? Please call as soon as possible. With an investigation, our San Jose workers’ comp denial attorneys might be able to prove that you should have been classified as an employee, not an independent contractor, which would make you eligible for workers’ compensation insurance coverage paid for by your employer.
You might be a misclassified employee if your employer requires you to:
- Work on a set schedule and chooses your workplace.
- Wear a certain uniform and follow precise instructions.
- Use tools or equipment provided by the company.
We have helped many local workers who filed their taxes as independent contractors because that’s what their employers called them, but who were actually employees under legal definitions. This could have happened to you, too, so let’s find out by discussing your options today.
Get Legal Help for Workers’ Comp Denials
Don’t accept a workers’ compensation claim denial at its surface value. We encourage you to always at least talk to our attorneys from Pacific Workers', The Lawyers for Injured Workers. During an initial consultation, we might be able to find a few solutions and ways to appeal the denial, so you can get the workers’ comp benefits that you need to recover from a workplace accident.
We look forward to hearing from you. Dial at any time.
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Workers' Comp FAQ
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What If My Employer Denies My Workers’ Compensation Claim Because I’m a Seasonal Worker?
Employers in California are legally required to provide workers' compensation coverage to all employees, including seasonal workers. If your claim is denied, it's advisable to consult with a workers' compensation attorney to understand your rights and explore options for appealing the decision.
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Am I Eligible for Workers’ Compensation?
In California, all employees are eligible for workers’ compensation with very few exceptions. If you are classified as an “employee” (rather than an “independent contractor”), you are eligible to receive benefits. This is true regardless of how many employees your employer has, how many hours you work, how much you make, whether you work part-time or full-time, or whether you are a seasonal worker. Additionally, undocumented workers are also eligible for workers’ compensation granted they meet all other eligibility requirements. In contrast, independent contractors and certain other workers, including some volunteers, household workers who are employed by a family member, and others, are not able to file for workers’ compensation benefits.
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Do independent contractors get workers’ compensation in California?
No, most independent contractors are not covered by workers’ compensation insurance that is provided by their employer. The law does not require most employers to offer this sort of employment benefit to independent contractors. To get workers’ comp as an independent contractor, you will usually have to purchase a policy on your own.
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Can't I Just File for Workers' Compensation on My Own?
Filing for workers' compensation on your own increases the chances that your claim will be denied. One small misstep can prevent you from obtaining the compensation you need for your injuries. In addition, the process is usually complex and tedious, especially for someone with no workers' compensation law experience. It is extremely advantageous that you seek reliable and experienced legal guidance for your claim.
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Are Independent Contractors Eligible for Workers’ Compensation Benefits?
Independent contractors are generally not eligible for workers' compensation benefits because they are not considered employees under California law. However, some employers may misclassify employees as independent contractors. If you believe you are misclassified, consult with a legal professional to assess your situation.
