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

Reasons workers comp may deny your benefits

On Behalf of | Jun 17, 2024 | workers' compensation

If you have filed a workers’ compensation claim, you know that there are a variety of reasons that they may deny the claim. It can be beneficial to understand some common reasons for denial, so you can do your best to avoid any issues and get the help you need after a workplace accident.

Incomplete or late paperwork

Filing paperwork on time is essential. If you submit forms late or with missing information, the insurance company may deny your claim in California. Always double-check your documents and meet all deadlines.

Non-work-related injury

If you get injured outside of work, workers’ compensation might deny your claim since it only covers injuries that happen on the job. Ensure you report the injury accurately, stating that it happened while performing job-related duties.

Lack of medical evidence

Medical evidence is vital for your claim. Without proper documentation from a doctor, the insurance company might reject your claim filing. Always visit a healthcare professional after an injury and keep records of all treatments and diagnoses.

Pre-existing conditions

If you have a pre-existing condition similar to your workplace injury, the insurance company might deny your claim. However, if your job aggravated the condition, you could still be eligible for benefits. Provide clear medical records showing the link between your work and the injury.

Employer disputes the claim

Sometimes, employers dispute claims by arguing that the injury did not happen at work or that you were not performing job duties. In such cases, gather as much evidence as possible, including witness statements and accident reports, to support your claim.

Failure to report the injury promptly

In California, you must report your injury to your employer as soon as possible. Delaying this report can lead to a denial. Promptly informing your employer helps ensure a smoother claims process.

Ensuring your claim’s success

To avoid denial of your workers’ compensation benefits, it is important to understand what steps to take to avoid having the insurance company deny your benefits. Taking these steps can help secure the benefits you need, so you can focus on healing.