Gilroy Workers' Compensation Appeals Attorneys

Lawyers Helping Injured Employees Respond to Denied Claims in Santa Clara County

If you are injured at work or as a result of your work responsibilities, you are entitled under California law to file a workers' compensation claim with your employer, seeking benefits to cover your medical care and a portion of your lost wages due to temporary or permanent disability. However, there is no guarantee that your employer will accept your initial claim. If your claim is denied, it is important to understand your options for appealing the decision.

A workers' compensation attorney is especially important when you are dealing with a denied claim. At Cramer & Martinez, LLP, we have a thorough understanding of the workers' comp appeals process based on over 20 years of combined experience. We will help you complete the required filings and prepare for your hearing with the goal of reaching an agreement or outcome that provides you with the full benefits to which you are entitled.

Why Would a Workers' Compensation Claim Be Denied?

If you experience a work-related injury or illness, your first step should be to notify your employer as soon as possible and submit a claim form to be reviewed by your employer's claims administrator. The administrator may accept your claim without issue, making it relatively easy to receive the benefits you need. However, it is possible for the administrator to deny your claim, perhaps on one of the following grounds:

• The injury was not related to your work. This argument is unlikely if you suffered an immediate injury at your place of work during work hours, but it is a possibility in the case of a repetitive stress injury or occupational illness that develops over time.
• The injury does not require medical treatment or missed time from work. The claims administrator may argue that your injury is not serious enough to require any medical care, or that you do not have significant justification for temporary disability benefits because the injury will not prevent you from performing your regular job tasks for any significant time.

If you disagree with the claims administrator's assessment, or if you believe they do not have justification for their decision, you have the right to pursue an appeal.

The California Workers' Comp Appeals Process

If you choose to pursue an appeal, you should prepare for the following process, and know that your attorney can guide and represent you from start to finish.

1. File an Application for Adjudication of Claim. This is the first step to ensuring that your case can be heard by a workers' compensation judge. The form should be submitted to your county's Division of Workers' Compensation office and served to the claims administrator responsible for reviewing your case. The deadline for filing your application is typically one year from the date of your injury or your awareness of the injury.
2. File a Declaration of Readiness to Proceed. If your efforts to resolve a dispute with the claims administrator have proven unsuccessful, you can file a Declaration of Readiness to Proceed, which officially requests a hearing with a workers' compensation judge.
3. Attend a Mandatory Settlement Conference. At the settlement conference, your attorney, the claims administrator, and any other parties to the case will meet with the judge with the goal of reaching a settlement. If the settlement is successful, this may be the end of your appeal.
4. Prepare for a trial. If the settlement is unsuccessful, the judge will schedule a trial and may order a pre-trial discovery period, during which you and your attorney will prepare to present evidence supporting your claim. After reviewing the evidence, the judge will issue a decision.
5. File a Petition for Reconsideration. If, after the judge's decision, your claim is still denied, you can petition for reconsideration with the California Workers' Compensation Appeals Board if you believe the decision was unfair or incorrect. Your attorney will advise you as to whether you have a strong case for an appeal.

Contact a Morgan Hill Workers' Compensation Lawyer

The workers' compensation claims process can be complicated under any circumstances, but especially when your initial claim has been denied. We can help you handle the challenges of your appeal and ensure that you pursue all possible options for obtaining the benefits you need. Contact us at 408-848-1113 for a free consultation. We serve clients in Gilroy, Morgan Hill, Hollister, San Jose, Salinas, Los Banos, Watsonville, and throughout Santa Clara County, San Benito County, Monterey County, Santa Cruz County, and the surrounding areas.