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Common Reasons for Denial of Workers’ Compensation Claims

By Kenton Koszdin Law Office on January 26, 2018 | In Workers Compensation Claims

You are probably eligible for Workers’ Compensation (WC) if you have been injured at work or if you have an occupational disease caused by your job.

However, there are some circumstances that will cause a WC claim to be denied. Here are some of the most common reasons for denial:

  • Missing the deadline to file or report your claim. In California, you must fill out a DWC-1 form and submit it to your employer within 30 days of being injured or becoming aware of your condition of an illness. Your employer will then file a claim with the insurance carrier, and you should receive a claim status letter from the insurance company within 14 days. Generally, the statute of limitations for filing a WC claim or appeal is typically one year from the date of the injury or illness.
  • Not seeking appropriate medical care.
  • Using an unauthorized medical provider.
  • Your injury or illness is not severe enough to qualify.
  • Claiming an injury that did not occur on the job. Generally, pre-existing conditions that were worsened at work are not covered. Any injury suffered while commuting generally is not covered.
  • A claim that is missing witness statements supporting your report.
  • Your doctor feels that you are able to perform a modified or alternate form of work that your employer offers. In this case, you have to do the alternate work until you can get a second medical opinion.
  • Your employer states that your condition is not work-related in order to save money on insurance liability and expense. Here, you must gather more evidence of your inability to work such as witness testimony and a doctor’s statement.

If your WC claim is denied, you have the right to appeal that decision and appear before the Workers’ Compensation Appeals Board. At this point, it’s a good idea to consult with an attorney experienced in Workers’ Compensation appeals.

We Can Help with Your Workers’ Compensation Claim and Appeal

If you or a loved one has been denied Worker’s Compensation or Social Security Disability (SSDI) benefits, it’s important to get an attorney experienced in these types of cases involved immediately. Call 800.438.7734 for your initial free consultation, either in our office or in the comfort of your own home. The Kenton Koszdin Law Office, Social Security attorney in Van Nuys, can help you navigate the application process for the best possible outcome for you and your family.

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