In California, you’re entitled to workers’ compensation if you’re injured in your workplace. You have to file for a claim to receive the compensation. But before you receive the compensation, an investigator must validate the claim. They will investigate the cause and the nature of the injury to determine if you qualify for the worker’s compensation. You either file an occupational disease claim or a claim for injuries sustained while at work. According to California law, not every person is eligible for compensation. Some injuries are also not covered by workers’ compensation. For example, if you’re an independent contractor and you fall off a slippery floor in the building, the company cannot pay you compensation since you aren’t an employee.
Unfortunately, most employers and insurance firms aren’t too eager to pay the claims. They will find various reasons to deny you the compensation. If you file for compensation and your employer turns it down, it's critical to enlist the services of a well-experienced workers’ compensation lawyer.
If you or your loved one needs to file a compensation claim in Los Angeles, do not hesitate to contact The Workers Compensation Lawyer Law Firm. Our number one priority is to help you receive your rightful compensation after a workplace injury. We will enthusiastically handle the case on your behalf from beginning to end. We will help you navigate the complicated maze, which is the California compensation claim process. With us, you are assured you will receive your rightful compensation. Give us a call today for a free consultation.
Understanding How California Workers Compensation Claim Works In California
Insurance companies and your employer may find it easy to deny your claim since California’s workers’ compensation process is complicated. The state has many regulations governing when, how, and how much your employer can compensate you for the injuries you sustain at work. The insurance companies and employers also want to save money by denying your worker’s compensation claim. Workers’ compensation costs your employer a lot of money. The insurance companies also increase the premiums when employees who have been injured in the workplace file claims.
The higher the number of insurance claims filed by the workers, the higher the employer’s premium to pay. Therefore, your employer may deny your workers’ compensation claim to prevent the increase in insurance premium. The premium also goes up when you file a particularly expensive claim. Therefore, the insurance company and the employer thoroughly investigate the claim. You need to enlist the services of an experienced California workers’ compensation lawyer when your employer or the insurance company denies your claim. The lawyer will represent you, and the judge is more likely to rule in your favor.
To prevent the premiums from going up, the employer tends to downplay the seriousness of an injury. They will claim the injury isn’t serious, or it’s not valid. Your employer may suggest you aren’t truthful about your back injuries or other repetitive injuries.
In most cases, injuries which you can’t wholly prove and verify medically give the employers a golden opportunity to deny your compensation claim. If x-ray or other imaging technology can’t confirm your injuries. In that case, the insurance company and your employer will most likely deny the claim even if you sustained the injuries at work. If you find yourself in such a situation, it's critical to use the service of an experienced California workers’ compensation attorney. They will help you prove in court the injuries are indeed work-related and you need compensation.
Below are some defenses you can use when your employer denies the compensation claim.
The Defense You Can Present When You Are Denied Compensation For The Injury Not Being Work-Related
Employers and insurance companies will find any reason to legally deny you compensation for any injuries you suffer at work. Your employer may claim you didn’t sustain the injury at your workplace, and therefore it isn’t work-related. They may also claim you weren’t at work when you injured yourself. According to California law, to receive workers’ compensation, the injury or sickness must have happened while at work or conducting work-related activities. Therefore, it means if you’re injured while commuting to or from work, eating lunch, or at a convenience store during your coffee break, you can’t claim workers’ compensation.
You must also report any injury you sustain at work immediately or as soon as possible. It might be difficult to receive workers’ compensation If the injury or sickness worsens while away from your workplace. Failing to report your injury on time might significantly affect the chance of successfully filing for workers’ compensation.
It’s important to gather the evidence you were at work if your employer claims the injury is not work-related. The evidence will help you refute these claims. It's also critical to work with a workers’ compensation lawyer who will help you appeal the decision to deny you the compensation claim. You can gather evidence by taking photographs of your injuries and the scene of the accident. You can also gather records which show you clocked into work and you were on the premises. Your workmates can also testify on your behalf that you sustained the injury while carrying out work-related duties.
Another important piece of evidence is the medical report. The report shows the injuries were a direct result of the accident you suffered at work. In some cases, the insurance company will require an Independent Medical Examination. They may demand an IME if they aren’t satisfied or do not trust your doctor’s medical report.
You can use an IME to resolve a dispute which arises towards receiving your compensation. The TIME will verify the finding of your doctor, and the insurance company can no longer claim your medical reports aren’t trustworthy. The IME will reveal the cause and the extent of your injury. It will also show the treatments and drugs you need to cure the injury or sickness. It’s critical to speak with your lawyer before you obtain the IME. The attorney will guide you on the best way to go about the process.
Defenses You Can Use When The Employer Claims You Are Not Employed By The Company
According to California labor laws, you have to be employed for you to receive workers’ compensation. To successfully file for a work-related injury claim, you have to be under active employment with the company. You also have to prove that were it not for your job. You wouldn’t have suffered the injury. The insurance company can deny your claim to prove you weren’t under active employment during your injury.
In California, it’s possible to appeal the denial. It’s critical to employ the services of an experienced California workers compensation lawyer to have a better chance of successfully appealing the denial. workers’
Maybe you suffered the injury while still working at the company but later left either through resignation or layoff. You may have a valid reason which prevented you from reporting the injury immediately or as soon as you got injured. It’s also possible your employer unlawfully fired you because you couldn’t perform your duties due to the injury. All these are defenses you can use against an employer who claims you weren’t employed by the company when you sustained the injury.
Defenses Against Claims By Your Employer You Didn’t Meet Deadlines While Reporting The Accident.
According to California law, you have a timeframe within which you must report a work-related injury. If you suffer an injury or develop sickness symptoms due to your job, it's critical to notify your employer immediately or as soon as possible. The law gives you a grace period of between thirty to sixty days to report the injury. You can notify your employer or supervisor verbally or through writing. You can also tell the employer about the injury personally, send your spouse, a friend, or through your doctor. If you fail to file for the compensation within the specified period, your employer can deny your compensation claim.
In some cases, it's possible you gave notice but didn’t file for the claim. Such a scenario can occur if the injury or sickness was severe and you couldn’t file the claim. If your employer denies the claim on these grounds, your lawyer can argue you gave notice of the injury, but you weren’t in a position to file for the claim. To prove you gave the notice, you can present coworkers who heard you report the injury to your employer. Your doctor can also testify on your behalf that they reported your injury to your employer. They can also present medical reports which show the injury you sustained at the workplace when performing work-related duties.
Defenses You Can Use When The Employer Claims You Didn’t Notify Them Of Your Stress-Related Injuries On Time.
In California, you have to report your injury within a certain time frame. It’s possible to suffer from job-related stress. If that’s the case, you are eligible for workers’ compensation. The stress may be due to the job conditions, the terms of the job like working long hours, or a poor working environment like having a rude and obnoxious boss or supervisor. The law in California has guidelines on the severity of stress-related injuries for which you can file for compensation.
According to California law, you can’t file for a stress-related compensation claim unless you’ve worked for the firm for six months or more. Additionally, job-related stress must contribute to at least 51% of the psychological condition. Job stress must also be the predominant factor causing the psychological condition.
Your employer or insurance company will conduct an independent investigation to determine the extent of the injuries. They will deny the claim if they determine the injuries aren’t as severe as you claim or don’t meet the threshold set by the law. You should present a medical report to support your claim if your employer or the insurance company denies your claim on the grounds that the injury isn’t as severe as you claim. You also need to consult your attorney to find out the evidence you require to support your claim. Presenting strong evidence will increase your chances of receiving your compensation.
Not all physicians can treat stress-related injuries. You should seek the services of a qualified psychologist to diagnose such cases.
It's possible to suffer certain injuries due to prolonged exposure to harmful substances. For example, if you’re exposed to toxic substances at your workplace, the injury may not be instantaneous. It might occur over a period. Similar to stress-related claims, it's critical to explain to your doctor that the injury results from continuous exposure to harmful substances at your workplace. It’s usually more difficult to prove cumulative injury than it is to prove a single instance injury. That’s why it's critical to employ the services of a California workers’ compensation lawyer to represent you in court. The lawyer will present evidence to support your claim.
Defenses You Can Use When The Employer Claims Self-Inflicted Injury
If you inflict injuries on yourself, the employer is under no obligation to compensate you even if you sustain injuries at your workplace. Should you intentionally cut your figure in the kitchen when preparing food or intentionally fall off a ladder and sustain injuries. In that case, the employer is under no obligation to compensate you for the injuries. Also, if you suffer an injury due to a fight with a fellow worker, your employer is under no obligation to pay workers compensation. They may even sue you if they discover you injured yourself on purpose to claim workers’ compensation.
If your employer or insurance company denies the compensation claim, it's imperative to seek the services of a workers compensation lawyer. You will need to gather evidence to prove the injury isn’t self-inflicted. You can ask a coworker to testify that the injury was not self-inflicted. Your doctor can also testify the injury can’t be self-inflicted according to their expert opinion.
Suppose your job is especially risky, or you operate various machines. In that case, your employer may claim you failed to follow the safety measures and suffered the injury due to your negligence. You can refute these claims by presenting evidence that shows you followed all the safety requirements. The evidence should show the accident was not self-inflicted. Additionally, you should also prove the accident occurred when performing your work-related duties and you didn’t in any way instigate the accident.
Defenses You Can Use When The Employer Claims You Failed To Meet The Medical Requirements For Workers Compensation Claim
If the insurance company isn’t satisfied with your doctor’s medical report, they can request an independent medical report. The purpose of the IME is to verify the injury is work-related. The purpose of the IME is to determine the extent of the injury and the treatment you might require. The IME also determines the length of the treatment. The independent medical report also reveals if you need any other medical assistance to help heal.
It’s critical to attend the IME. Failing to appear for an independent medical examination could give the insurance firm grounds to deny your claim. You should enlist the services of a workers’ compensation lawyer if you couldn’t make it to the IME. Your lawyer can argue you couldn’t attend the IME due to unavoidable circumstances.
Defenses You Can Use When The Employer Claims You Were Engaging In Illegal Activities
Your employer can deny your workers’ compensation if they claim you sustained the injury while performing illegal or unauthorized activities at your workplace. For example, your employer may deny your compensation if they claim you sustained the injuries due to drunkenness or engaging in careless behavior. If you’re denied claims on such grounds, seek the services of a workers’ compensation lawyer. They can argue you weren’t drunk or your actions were in no way reckless.
Defenses You Can Use When The Employer Claims Denied Compensation Due To Horse-Play
Horse-play is when you engage in playful activities in the workplace. If your employer claims you were horse-playing and you sustained the injuries, they can deny your claims. However, you can defend yourself against such allegations by presenting evidence that you weren’t involved in any form of horse-playing. You can present the evidence through your coworkers, who can state you weren’t horse-playing when you sustained the injury. They can state, you were performing your work-related duties.
Defenses You Can Use When The Employer Claims You Aren’t Covered Under The Workers Compensation.
In California, not all workers are covered by workers’ compensation. Some workers, like certain executives, domestic or agricultural employees, don’t fall under the workers’ compensation plan. They have their policies which they operate under at their workplace. If you fall under this class, you can’t file for workers’ compensation claims.
However, even if you aren’t under the workers’ compensation plan, it doesn’t mean you aren’t eligible for compensation if you suffer a job-related injury. If you are injured while at work, your employer should compensate you for the injury.
What You Should Do If Your Workers Compensation Claim Is Denied
It can be a frustrating experience if your employer or the insurance company denies your worker compensation claim. However, if this happens, you shouldn’t give up because you have recourse. The insurance company will state in the letter the reason for denying you the compensation claim. If you feel the denial is a simple misunderstanding in communication or an error in the paperwork, you can contact the insurance adjuster.
If the employer or the insurance company made a mistake that led to the denial, you could solve the issue quickly and amicably. However, this is not usually the case. Challenging a denial is mostly a grueling affair. Remember, your employer and the insurance company don’t want to pay the compensation. Therefore, it’s usually necessary to appeal the decision. Since the appeal process can be stressful and complicated, it's advisable to seek the services of a well-experienced California workers’ compensation lawyer.
The information on the letter of denial will help you file an appeal. To file an appeal, you request a hearing before the state’s workers compensation appeals board. This is an informal hearing, and the judge will listen to arguments from both sides. They decide on whether the insurance should accept your claim.
To officially file an appeal for the denial, you must fill the Declaration of Readiness to proceed. After filing the form, you are now ready to start the official process of appealing the insurance company’s decision to deny your workers’ compensation claim.
Call A Los Angeles Workers Compensation Lawyer Near Me
You should not give up If the insurance or your employer denies your claim for injuries sustained when performing your duties. You shouldn’t also shy away from filing the claim even if your employer feels it's an unnecessary claim. If your claim is denied for whichever reason, it's critical to enlist the help of a workers’ compensation lawyer. Remember, it's your right to sue your employer if they deny your claims. If the reason for the denial is a simple misunderstanding, you can sort out the issue with the insurance company or your employer.
However, if the denial is more technical, you need to enlist a qualified workers’ compensation attorney. The process to appeal the decision is often complicated and rigorous. You need to present strong evidence to convince the judge to award you the claim. A lawyer will prepare a strong case and help you receive the compensation.
Contact The Workers Compensation Lawyer Law Firm if your worker’s compensation benefits have been denied, or you know a loved one whose benefits have been denied in Los Angeles. We have represented many clients and have a wealth of experience, and perfectly understand the intricacies of the California workers compensation law. Our dedicated attorneys will work tirelessly to ensure you receive the benefits that you need and deserve. Allow us to be of help during this challenging time. Do not hesitate to contact us at 424-501-9228, and we will be more than happy to assist.