Los Angeles Workers’ Compensation Denial Lawyer
As an employee, you are entitled to workers’ compensation benefits if you are injured or become ill because of your job. Your employer is mandated by law to carry insurance or self-insure, so your medical care and a portion of your wages are covered after a short waiting period.
It sounds easy, but for various reasons, a claims administrator can deny you benefits. If this happens to you, do not panic. Call us. Our Los Angeles workers’ compensation denial lawyers are competent and experienced at getting denials overturned.
Reasons Why Workers’ Compensation Benefits are Denied
Employees have some responsibilities to apply for workers’ compensation benefits; they are not automatic. Among the denials workers can face include:
- Missing the 30-day deadline to report a work-related injury to a supervisor
- Notice is given, but the written claim to the insurer is not filed within the one-year deadline
- A claim is submitted, but proof that it is work-related is not adequate
- The injured employee submits the claim after being terminated
When administrators deny workers’ compensation claims, many workers give up, but with the assistance of a competent and skilled Los Angeles attorney, appeals often turn the denial into acceptance.
Claim Administrators Determine Benefits
Claim administrators are certified under state law to fairly determine if an injured employee is owed workers’ compensation benefits. They must be recertified by attending a thirty-hour continuing education program every two years.
When administrators deny a claim, the Division of Workers’ Compensation (DWC) can step in to assist them and all involved parties to rectify the decision through a state-approved process governing the insurance-driven system. Some claims, such as missing information, are simple to fix, and the DWC, an injured employee through their lawyer, and the administrator could resolve the issue through the Information and Assistance Unit. Let a Los Angeles lawyer work with state and insurance agencies to reverse a workers’ compensation denial.
How Does Workers’ Compensation Appeal Work?
Workers can ask our Los Angeles attorneys to file an Application for Adjudication of Claim to appeal a denial of workers’ compensation benefits. At this point, a qualified medical evaluator (QME) becomes involved to examine the denied worker and assess prior medical records to determine if they disagree with another physician’s treatment plan.
QMEs are licensed physicians the DWC specially certifies according to their specialties, including cardiologists, psychiatrists, orthopedic surgeons, and catastrophic injury specialists. To become certified, these physicians must participate in special training to evaluate workers’ compensation injuries.
Once the QME treats the injured worker, a Declaration of Readiness to Proceed is filed to obtain a court hearing in front of a workers’ compensation judge.
The court hearing is a mandatory settlement conference attended by the administrator and the injured party’s attorney. If the denial is not resolved, the workers’ compensation judge schedules a trial to be presided over by another judge. The new judge will issue a ruling within 90 days of the trial’s conclusion.
A Los Angeles Workers’ Compensation Denial Attorney Gets You Benefits
If you work for a California employer, you are covered by workers’ compensation insurance that pays for medical care, replaces a portion of your wages, and offers temporary and permanent disability, retraining, and death benefits for your family. Despite the comfort of knowing this, if your claim is denied, you will be shocked and unsure what to do next.
Call us. We know what needs to be done after benefits are denied. We determine what is missing from your application and organize your appeal to be successful, including representing you at hearings and before a trial judge. Our Los Angeles workers’ compensation denial lawyer is standing by to receive your call.
