Attorney Esequiel Solorio is a certified specialist in workers’ compensation law as certified by The State Bar of California Board of Legal Specialization.

Top reasons for workers comp denials

On Behalf of | Oct 16, 2018 | Blog

Workers who suffer an employment-related injury in California turn to workers’ compensation to obtain the benefits they need to get medical treatment and make up for lost wages. Understanding why some claims receive a denial can help you avoid common mistakes that delay or prevent much-needed benefits.

If you do receive a denial, it is most likely not the end of the road; you still have recourse to filing an appeal. Be sure to act promptly, as the appeals process runs on strict deadlines.

Reporting too late

According to California workers’ compensation rules, you need to notify your employer about your injury within 30 days of its occurrence. For conditions that develop gradually, such as respiratory disease or carpal tunnel syndrome, this period generally starts from the day you get a diagnosis and/or learn your condition has worsened in relation to your work. To avoid potential problems, it is best to report as soon as you are able. Your employer may have you fill out a specific form; if not, be sure to confirm your report in writing if you initially made it verbally. This way, you have documentation of your timely report.

Not complying with treatment

To proceed with your claim, you need medical documentation of your injury or condition and reports concerning your current and future treatment, as well as an assessment of how your condition may continue to affect you. Insufficient medical documentation can lead to a denial of your claim.

Although regular treatments and medication regimens can cause both physical discomfort and a disruption to your schedule, it is important to comply with your provider’s treatment plan. Failing to do so can lead the insurer concluding that you no longer need treatment.

Employer claims injury did not relate to work

Finally, sometimes employers may dispute that your injury or condition relates to your work. If there are any circumstances surrounding your injury that may bring this into question, it is best to seek qualified legal assistance before filing your claim. This way, you get advice about the best way to document your injury’s connection to your employment.