My Workers Compensation Claim Was Denied. Now What?

 Posted on May 20,2021 in Denied Claims and Appeals

In California, employees who are injured on the job are entitled to reimbursement for medical expenses and part of their lost income through workers’ compensation. With some exceptions, anyone who is hurt while performing work tasks is eligible for workers’ compensation or “workers’ comp.” However, some workers’ compensation claims are denied. If you or a loved one applied for workers’ compensation and were denied, a workers’ compensation lawyer may be able to help.

When is a Worker Not Entitled to Workers Compensation?

California workers’ compensation is extensive and covers most individuals. However, there are some exceptions to this generality. For example, if you work in exchange for housing or other aid instead of wages, you do not qualify for workers’ compensation. Individuals who are employed by their parent, spouse, or child in a family business may also be excluded from workers’ compensation. You do not qualify for workers’ compensation if the injury was not related to your job or it occurred when you were off the clock.  

Only workers who are classified as employees are entitled to workers’ compensation. So, if you are an independent contractor, you may not receive reimbursement for your medical expenses or lost income. That being said, many workers who are classified as independent contractors should be classified as employees. A workers’ compensation attorney can help you determine if you have been misclassified.

What Can I Do I Qualify for Workers’ Compensation but I Was Denied?

If you qualify for workers’ compensation according to the criteria established by California law but you were denied coverage, you can file an appeal. To do this, you will need to request a hearing with the local Workers’ Compensation Appeals Board. During the hearing, a judge considers the facts of the case and issues a ruling. The judge may uphold the denial or reverse the insurance company’s decision and force the insurance company to accept your claim. A workers’ compensation lawyer can help you gather evidence and build a strong argument to present at the hearing. Your lawyer will represent your best interests and help you pursue the compensation you need.

Reach Out to a Santa Clara Workers’ Compensation Lawyer

If your workers’ compensation claim was denied, contact a Gilroy workers' compensation attorney from Cramer & Martinez, LLP. We can help you understand your legal rights and determine what the next steps should be. The appeals process can be complicated and frustrating – especially when you are already dealing with the consequences of your injury or illness. Let us help. Call 408-848-1113 for a free consultation.

Source:

https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=LAB&division=4.&title=&part=1.&chapter=2.&article=2.