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santa clara workers compensation lawyerIn 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.

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California workers' compensation lawyersWorkers’ compensation benefits can help an injured worker pay for medical expenses and other costs related to a work injury. However, filing a workers’ compensation claim and successfully recovering benefits is often more difficult than many workers expect. If your workers’ compensation claim was denied, you may be worried about how you will pay your bills and receive the medical care you need. Fortunately, you may be able to appeal a workers’ compensation denial.

Determining the Reason for Workers’ Compensation Denial

If you or your loved one was denied workers’ compensation after a work accident, you may be confused and unsure as to why the claim was denied. Workers’ compensation claims are denied for many reasons. In some cases, the insurer or employer may simply not have received enough information about the injury to make a proper assessment about workers’ compensation benefits. Mistakes made on the part of the injured worker or the insurer/employer may also lead to delays or denials. Workers’ compensation benefits are contingent on the injured worker meeting specific filing requirements and deadlines. The insurer or employer may also deny you if the way you were injured makes you ineligible for benefits. Injuries that occur while a worker is under the influence of drugs or alcohol, self-inflicted injuries, injuries caused by a preexisting condition, or injuries that are unrelated to work are not typically covered by workers’ compensation. Employers or insurance companies sometimes wrongfully deny workers’ compensation claims.

Appealing the Decision

If you were denied coverage under California workers’ compensation laws, you have the option of appealing the decision. To do so, you must file a form called a “Declaration of Readiness to Proceed.” You may then attend a hearing with the Worker’ Compensation Appeals Board (WCAB) and argue your case in front of a judge. A workers compensation lawyer can help you fight for the benefits you need. Your lawyer will help you use medical records and other evidence to demonstrate your eligibility for workers’ compensation and represent you during the hearing. If a settlement cannot be achieved, your attorney can also represent you during trial.

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