Santa Rosa Workers' Compensation Denial Attorney
Has Your Workers' Compensation Claim Been Denied?
Workers in Santa Rosa face numerous risks on the job every day. Whether you're a construction worker laboring under the sun, a nurse attending to patients in a hospital, or an office employee spending long hours at a desk, workplace injuries can happen unexpectedly, leaving you in physical pain and financial distress. In such times, the workers' compensation system is designed to provide crucial support to employees injured on the job.
However, the sad reality is that many legitimate workers' compensation claims are unfairly denied by insurance companies. When you're dealing with a denied claim, the world can seem unjust and overwhelming. That's where Pacific Workers', The Lawyers for Injured Workers, comes to your rescue. Our expert team is here to help you navigate the complex process of workers' compensation claims and particularly, the stressful situation of claim denials.
Call (888) 740-6434 or contact us online today to schedule a free consultation.
Why Was My Claim Denied?
A workers' compensation claim denial occurs when an employer's workers' compensation insurance company refuses to provide benefits to an injured worker. In California, as in many other states, workers' compensation is a system designed to provide medical benefits and wage replacement to employees who are injured or become ill due to work-related activities. However, there are various reasons why a claim may be denied.
Common reasons for workers' compensation claim denials in California include:
- Failure to Report in a Timely Manner: In California, an injured worker is typically required to report the injury to their employer within 30 days. Failure to do so can lead to a denial of the claim.
- Missed Filing Deadlines: There are strict deadlines for filing a workers' compensation claim in California. If the injured worker or their employer fails to meet these deadlines, the claim may be denied.
- Disputed Injury: Sometimes, the insurance company may dispute whether the injury is work-related. If it's unclear whether the injury occurred on the job, the claim may be denied until further investigation is conducted.
- Preexisting Condition: If the insurance company believes that the injury is the result of a preexisting condition or a non-work-related event, they may deny the claim.
- Lack of Medical Evidence: Proper medical documentation is crucial for a workers' compensation claim. If there is insufficient medical evidence to support the claim, it may be denied.
- Injury Not Severe Enough: In some cases, the insurance company may argue that the injury is not severe enough to warrant workers' compensation benefits. There are specific criteria for what qualifies as a compensable injury.
- Intoxication or Drug Use: If the employee was under the influence of drugs or alcohol at the time of the injury, this can be grounds for a claim denial.
- Fraud: If the insurance company suspects that the claimant is attempting to defraud the system, they may deny the claim.
- Failure to Cooperate: If the injured worker fails to cooperate with the claims process, such as refusing to provide necessary information or attend medical evaluations, the claim may be denied.
- Excluded Activities: Some activities that occur while on the job may not be covered under workers' compensation, such as injuries sustained during recreational activities or acts of violence that were not work-related.
You Can Appeal a Denial
Once the insurance company denies your claim, you can file an appeal. The most effective way to appeal your denial is by having a lawyer on your side in many situations. A denial often comes following a small miscue in the initial paperwork.
A lawyer can help you file the necessary paperwork timely and effectively. An attorney helps confirm accuracy in the paperwork to limit the insurance company’s chances to deny your claim a second time. When you file an appeal, make sure you have someone on your side who can strengthen the position of your claim.
What Can I Do If My Claim Is Denied?
If your workers' compensation claim is denied, it can be a stressful and challenging situation to navigate. However, you do have options to address the denial and seek the benefits you rightfully deserve.
Here are the steps you can take if your workers' comp claim is denied:
- Review the Denial Letter: Start by carefully reviewing the denial letter you receive from the workers' compensation insurance company. This letter should explain the reasons for the denial and outline the process for appealing the decision.
- Contact Your Employer: Reach out to your employer or supervisor to discuss the denial. Sometimes, misunderstandings or errors in the paperwork can be resolved at this stage.
- Consult an Attorney: It's advisable to consult with an experienced workers' compensation attorney, especially if your claim has been denied. They can provide legal advice and guide you through the appeals process. Many attorneys offer free initial consultations.
- File an Appeal: In California, you have a limited time to file an appeal after your claim is denied. The specific deadlines can vary, so consult with your attorney to ensure you meet them. To initiate the appeal, you typically need to complete the appropriate forms, which your attorney can help you with.
- Gather Additional Evidence: Your attorney will work with you to gather any additional evidence needed to support your claim. This may include medical records, witness statements, or expert opinions to demonstrate that your injury is work-related.
- Attend a Hearing: In California, denied workers' compensation claims often go through a hearing process with the Workers' Compensation Appeals Board (WCAB). Your attorney will represent you at the hearing, presenting your case and arguing for the benefits you deserve.
- Negotiate a Settlement: Prior to or during the hearing process, your attorney may negotiate with the insurance company for a settlement. This can result in a lump sum payment or ongoing benefits, depending on your case's circumstances.
- Explore Alternative Dispute Resolution: In some cases, mediation or arbitration can be used as alternative dispute resolution methods to reach a resolution without going to a formal hearing. Your attorney can advise you on whether this is a suitable option for your case.
- Follow Medical Treatment Plans: Continue following your prescribed medical treatment plans and attending all necessary medical appointments. This helps establish the ongoing need for benefits.
- Keep Records: Maintain records of all communication related to your claim, including emails, letters, and notes from conversations with your employer, the insurance company, and your attorney.
- Stay Informed: Stay informed about your rights and responsibilities throughout the process. Your attorney will provide guidance, but it's essential to be an active participant in your case.
- Stay Patient and Persistent: The workers' compensation appeals process can be lengthy, but persistence can pay off. Trust your attorney's expertise and be prepared for a potentially protracted legal battle.
Remember that each workers' compensation case is unique, and the steps you take may vary depending on the specific circumstances of your denial. Consulting with an experienced workers' compensation attorney, like those at Pacific Workers', The Lawyers for Injured Workers, can significantly improve your chances of a successful appeal and obtaining the benefits you deserve.
If you've received a denial on your workers' compensation claim and need legal advice or assistance with an appeal, don't hesitate to contact us at Pacific Workers' for a free consultation.
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The most down to earth team I have ever met!
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I got a compensation package that I was very happy with!
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I would highly recommend PWC!
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Your team was great to work with!
“You took nothing and made it out of something. I felt like I mattered! Everyone was very professional and caring.”
Heather Flores Bakersfield, CA -
“¡Farber hizo que fuera muy fácil y sin estrés para mí! Ellos hicieron todo el trabajo duro y me hicieron sentir tranquila en la situación que estaba atravesando. Nunca habría esperado que el resultado fuera tan bueno. Me mantuvieron al día de todo lo que pasaba en mi caso. Todos los abogados con los que traté eran tranquilizadores y positivos. Recomendaría a Farber a cualquier empleado que necesite ayuda con su compensación de trabajadores.”
Janette D. -
Pacific Workers' Comp is one of the best places to get help from when you need help with an injury from work!
“Iana and Sergio are very helpful, and Pacific Workers' Comp is one of the best places to get help from when you need help with an injury from work they have been helping me out through my trying time and doing a damn good job with dealing with stuff that I can't handle and I really appreciate all their help if you ever need help with an injury at work this is the place to go.”
Lamar B. Santa Clara, CA -
Bilal is very professional, caring and committed to his clients!
“My lawyer Bilal took the time out on a late Friday afternoon to meet with me and answer some questions that I had. Who stays late and meets with you on a Friday afternoon? Very few do, Bilal does. It speaks to his professionalism, caring, and commitment to his clients. Which creates a culture value at PWC. This is only one example of my experience with them, there are many more just like this.”
Guy H. Novato, CA -
PWC has provided me with exceptional care!
“My experience with them has been exceptional. They are caring, devoted and professional. They had turned a stressful situation into one that does not cause anxiety.”
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The attorneys and employees at PWC are angels!
“Thank goodness for my team of lawyers and assistants that always take the time to listen to my concerns, answer my questions, and act on my behalf when my company does nothing!! Someone else said it, and I second that the people at PWC are angels!! At least I feel that someone is on MY side now!”
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I was lucky enough to obtain the services of Pacific Workers' Compensation Law Center!
“I was lucky enough to obtain the services of Pacific Workers' Compensation Law Center. They worked tirelessly to receive the best care, and finally a C&R settlement from SCIF for me. Without them, I would have been just another injured worker without medical treatment.”
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For anyone out there looking for a 'Worker's Comp attorney,' look no further!
“For anyone out there looking for a 'Worker's Comp attorney,' look no further. Robert Davis is the man you want on the case. Robert truly cares for his clients; he will help you through the tough times, with a no-nonsense approach to your situation. Robert is a good man that never leaves any doubt in your mind and always makes you feel like he is the best man for the job.”
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“I would recommend Pacific Workers' Compensation Law Center to my family and friends. I was so blessed to talk with AlMarie in March 2018 after receiving horrible service from another attorney's office. AlMarie took the time to talk to me and give me the information that I needed. Lauren and Alex are super great, and I feel I made a good decision for the law center to represent me. I received my packet with great information, resources, and how to communicate and contact the team who will be assisting me and working on my case.”
T. Davis Addison San Leandro, CA -
Jason exuded complete confidence in my case & really understood what I went through!
“My attorney Jason Insdorf exuded complete confidence in my case and made me feel like he really understood what I've been through (didn't hurt to read about his extensive credentials and expertise specific to my case). Karla Ortega made me feel at ease, listening intently when I explained details dating back 12+ years. Also, I was very impressed by the compassion, communication, and overall professionalism.”
Matthew U. Modesto, CA -
Pacific Workers' Compensation helped me get the justice I deserved!
“It was my first injury at a job and I did not know what to do. I did not know if my rights as an employee were being met. So, I was able to call to ask Pacific Workers' Compensation about my injury that occurred and what were my rights as an employee. They were able to help me get justice.”
Victoria M. Santa Cruz, CA -
After Pacific Worker's Compensation started handling my case, I started getting the respect of an injured worker and not just a number.
“My caseworker is amazing. She is quick to respond to my messages and concerns. Before contacting Pacific Worker's Compensation, I was getting the run around with my doctors and worker's compensation insurance for my employer. After Pacific Worker's Compensation started handling my case, I started getting the respect of an injured worker and not just a number.”
Brandy L. Fairfield, CA -
Bilal is always kind, professional, compassionate and explains everything thoroughly!
“Bilal Kassem is the nicest attorney a person dealing with a workers compensation mess can ask for. Always kind, professional, compassionate, and explains everything clearly.”
Emi B. Vallejo, CA -
They were a headache & stress rellief!
“Kiki was such a help. She works with Robert Davis. After dealing with the ins Co and there run around, blood pressure tossing, I turned my case one to PWC. No more headaches, no stressing, just relief. Thank you, Kiki and Robert & Pacific Workers Compensation.”
Debra McLaughlin Benicia, CA
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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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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.
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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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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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How Is Workers’ Compensation Calculated for Seasonal Workers?
Compensation for seasonal workers is typically based on your average weekly earnings during the employment period. If you're unable to work due to the injury after the season ends, eligibility for benefits may depend on factors such as your employment history and whether you usually seek other employment during the off-season.
