California Firm Handles Appeals of Denied Workers’ Compensation Claims

Attorneys in Fresno and Grover Beach seek to reverse adverse decisions

Learning that your workers’ compensation claim has been denied can make an already bad situation seem even worse, but there is no reason to give up. At the Law Offices of Valdez & Valdez, A Professional Corporation in Fresno and Grover Beach, we have won reversals for numerous injured employees in all types of cases. We understand the reasons why insurance companies turn down worthy claimants and develop strong arguments to use in settlement negotiations or proceedings before the Workers’ Compensation Appeals Board.

Reasons why workers’ compensation claims are denied

California law requires employers to maintain workers’ compensation coverage, which is intended to provide reimbursement for medical costs and lost wages stemming from a work-related injury or illness. Typically, claims decisions are made by insurance companies. Injured workers do not have to prove any fault on the part of the employer, yet some claims are still rejected for one or more of the following reasons:

• Lack of documentation — When you’ve been hurt in an accident at work, you should report it immediately to your supervisor. If you believe you are suffering from an illness or progressive healthcare problem as a result of your job, you should notify your employer when your condition is diagnosed. A delay in reporting longer than 30 days or the failure to provide authentic documentation regarding your condition could prevent you from collecting benefits. 
• Pre-existing condition — Frequently, insurers and employers try to justify a workers’ comp denial by stating that the medical problem in question is a pre-existing condition and not linked to the claimant’s employment. Medical and factual evidence might be necessary to support the claim. 
• Injury not incurred while performing job duties — There might situations where someone is hurt at work, but their employer alleges that they were not doing their job at the time. A claim could be denied because the company says that the injury occurred while the worker was intoxicated or engaged in a fight with a colleague. 
• Failure to see approved medical provider — Insurance companies usually have a network of doctors whom they have approved to review the condition of workers’ compensation claimants. Failure to keep an appointment with the medical provider or a refusal to follow instructions on treatment can be used to reject workers’ comp benefits.

Insurance companies might overlook the true nature of a workers’ compensation claim in an effort to avoid paying benefits. Our firm will look at the full set of facts and advise you as to whether the denial was justified.