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santa clara workers compensation lawyerMost people struggle with one or more medical conditions at some point in their lives. Whether you have an old sports injury, a degenerative disease, or hearing or vision problems, managing the condition’s symptoms may be a constant struggle. So what happens when work tasks aggravate an existing medical concern? Is the injured worker entitled to financial compensation through workers’ compensation? Is the worker barred from financial recovery because he or she had the condition before being hired?

California Workers’ Compensation Typically Covers Aggravation of Pre-Existing Conditions

Many people assume that they cannot get workers’ compensation for a medical issue that existed before starting their job. Fortunately, California workers’ compensation does cover situations in which a person’s job worsens a pre-existing medical problem. Unfortunately, it is often difficult to get the compensation you need for a pre-existing condition. To get reimbursement for medical bills and lost wages through your employer’s workers’ compensation insurer, you must prove that:

  • Your medical condition was aggravated or worsened by your job duties

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Hollister workers compensation attorney

Unlike in many other states, workers' compensation is mandatory for all employers in California. It does not matter if an employer has hundreds of employees or only one. It also does not matter if the injured employee was working full-time or part-time. Typically, self-employed individuals are not covered by the hiring entity’s workers’ compensation insurance. However, workers who have been misclassified as independent contractors may actually fall under the category of employee, which means that they would be entitled to coverage through workers’ compensation.

Individuals Who Are Not Covered by Workers Compensation in California

California has wider-reaching workers’ compensation coverage than many other states. However, there are still some individuals who are not covered by workers’ compensation, including:

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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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