When you’ve been injured on the job, the last thing you need is additional stress. Workers' compensation exists to protect you during these difficult times, ensuring you receive the medical care and financial support you need to recover. But what happens when your claim is denied? That denial can feel like a slap in the face, leaving you wondering where to turn.
Don’t worry—you’re not alone, and you’re not out of options. At Arshakyan Law Firm, we’ve seen countless clients stand up to unfair denials, and we’re ready to help you do the same. Speak to our Los Angeles Workers Compensation Attorneys to explore your legal options.
Common Tactics Insurers and Employers Use to Deny Claims
Denied claims often result from employers and insurers trying to protect their bottom line. While they may frame their reasons as legitimate, many of these denials are based on shaky grounds that can be challenged. Here are some common tactics they use:
Disputing the Cause of Injury
One of the most common ways insurers deny claims is by questioning whether the injury occurred at work. For example, they might argue that your injury happened off-duty or during non-work-related activities. Employers may also claim that your duties don’t align with the type of injury you suffered.
Insufficient Medical Documentation
Insurers may deny claims due to “insufficient evidence” linking your injury to your job. For example, if your doctor didn’t explicitly state that your injury is work-related, the insurer might argue that the connection is unclear. This puts the burden on you to provide additional documentation, often requiring legal help to compile and present the evidence effectively.
Pre-Existing Conditions
Another common excuse for denying claims is pointing to pre-existing conditions. For instance, if you’ve had back problems in the past and suffered a workplace injury affecting your back, insurers may argue that your condition existed before the incident. This tactic unfairly shifts the focus away from the fact that your work environment aggravated or caused the injury, which is what workers' compensation should cover.
Missed Deadlines
Workers’ compensation laws often include strict deadlines for reporting injuries and filing claims. Employers and insurers frequently use these deadlines to deny claims, even when delays are due to legitimate reasons, like delayed symptoms or lack of clarity about the reporting process. If you’ve missed a deadline, a workers’ compensation attorney can often argue that the delay was reasonable or caused by factors outside your control.
Alleged Employee Misconduct
Employers sometimes claim that the injury was caused by the worker’s own negligence or violation of company policy. These accusations can range from saying you weren’t following safety procedures to alleging that you were intoxicated at the time of the injury.
Steps to Take After Receiving a Denial
A denial is frustrating, but it’s not the end of the road. In fact, it’s your opportunity to regroup, gather evidence, and challenge the decision. Here are the steps you should take to fight back effectively.
Review Your Denial Letter
The first step is to read the denial letter you received carefully. This document outlines the specific reasons your claim was denied. Whether it’s due to insufficient evidence, a missed deadline, or another issue, understanding why your claim was rejected is essential for building a strong case. At Arshakyan Law Firm, we can help you break down the denial letter and identify the next steps to address the insurer’s concerns.
Gather Strong Evidence
Once you understand the reason for the denial, it’s time to gather evidence to support your claim. Strong evidence often includes:
- Detailed Medical Records: Ensure your doctor provides clear documentation connecting your injury to your workplace activities.
- Witness Statements: If coworkers witnessed the incident or are familiar with unsafe working conditions, their testimony can bolster your case.
- Accident Reports: If you reported the incident to your employer, copies of accident reports can serve as critical evidence.
- Photographs or Video: Visual evidence of the hazardous conditions that caused your injury can be highly persuasive
File an Appeal
If you’re ready to challenge the denial, the next step is to file an appeal. In California, the appeals process is managed by the Workers' Compensation Appeals Board (WCAB). To begin, you’ll need to submit a formal request for reconsideration, outlining why the denial was wrong and providing evidence to support your claim. Appeals must be filed promptly to meet California’s strict deadlines, so time is of the essence.
Once your appeal is submitted, your case will be reviewed in a hearing at one of Los Angeles’s WCAB offices. A workers’ compensation judge will evaluate the evidence and arguments from both sides before making a decision. This process can be overwhelming, especially when insurers bring in their own legal teams. At Arshakyan Law Firm, we handle every step of the appeal, ensuring your rights are protected and your case is presented effectively.
The Appeals Process Explained
Workers’ compensation appeals usually involve a hearing before an administrative law judge or a workers’ comp board. During this hearing, you can present evidence supporting your claim, including medical records, witness testimony, and other documentation. Mediation may also be offered as an alternative to a formal hearing, allowing you and the insurer to negotiate a settlement.
Consult a Los Angeles Workers’ Compensation Attorney
A denied workers’ compensation claim doesn’t just hurt your finances—it disrupts your life. You’ve been injured on the job, and now the system that’s supposed to protect you is turning its back. At Arshakyan Law Firm, we understand how overwhelming this can feel, but you don’t have to face it alone. No two cases are alike, so we take the time to listen to your story, review the details of your denial, and craft a strategy that works for your situation. Whether it’s gathering evidence, filing an appeal, or representing you during a hearing, we stand by your side every step of the way.
With years of experience and a deep commitment to justice, our firm has helped countless clients challenge unfair denials and win the benefits they need to recover. What makes us different is our focus on people. We don’t just represent clients; we advocate for individuals and families whose lives have been disrupted by workplace injuries. Call 888-851-5005 or contact us online today for a consultation.