Workers' Comp Claim Denied? Here's What to Do Next

Applying for workers' compensation is a lengthy and occasionally frustrating process. The process seems even more disrupting when you receive a notice in the mail that the workers' comp board has denied your claim, refusing you the benefits you deserve.

If the office denies your claim, you are sure to feel disheartened at first. After all, you are suffering from work-related injuries and want to recover, but instead you must focus on becoming financially stable.

Read this guide to know what to expect after you receive a denial of your workers' comp claim. You may have more options than you think.

Check Your Eligibility

First, check to make sure you are eligible to receive workers' comp. Simply being injured while at work does not mean you are instantly able to receive the funds. Cuts, bruises, scrapes, and light injuries linked to first-aid treatment do not make you eligible to receive workers' comp.

On the other hand, you are eligible to receive workers' comp for many accidents that occur in relation to work even if they do not occur in the office. Keep in mind, however, that accidents that occur during an activity like commuting are not eligible.

You should also talk to your workers' comp attorney to discuss the eligibility of your options for cumulative injuries and mental health injuries. While workers' comp may cover some injuries, it may have the right to deny others.

The workers' comp board may also determine that you can return to work, making you ineligible for the benefit. Workers' comp is meant to help you when your injuries are more severe and prevent you from working the way you used to.

Consult With a Workers' Comp Attorney

When you submit a claim only to be denied, the issue could be anything - even information that has been misspelled or a missing document. When you talk with a workers' comp attorney, you can work together to determine the best way to rectify the error and resubmit your claim.

The error could also be related to a lack of evidence of your injury or a lack of evidence that the injury was linked to one job specifically. A workers' comp attorney understands the best way to provide evidence of your injuries and their impact on your life.

Receive a Medical Evaluation

If you disagree about your workers' comp claim, you can opt for an evaluation with a qualified medical evaluator. The licensed doctor will determine the severity of your injuries and report them to the worker's comp board.

Appeal the Workers' Comp Decision

When your workers' comp claim has been denied, you have the right to appeal right away. In fact, you should act quickly because there is a time limit on submitting the appeal. You will file an Application for Adjudication of Claim through your division.

Once you file an appeal, the department will send you a case number. You can request a hearing in front of a judge, but you must first attend a settlement conference. During the hearing, you and the claims administrator will appear in court in an effort to reach a settlement. If you are unable to reach a settlement in this meeting, you will attend a pretrial conference and hearing.

Attend a Workers' Comp Hearing

The workers' comp hearing is similar to any other trial, except that workers' comp cases do not involve juries. Still, both sides present evidence and witnesses in order to appeal to the judge. During this hearing, you can rely on the expertise of your attorney. Ultimately, you will receive the results via writing in the mail.

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Cole, Fisher, Cole, O’Keefe + Mahoney is Central California’s leading workers’ compensation and social security disability law firm. With over 30 years of successful experience, we are committed to securing maximum benefits for our clients in the Fresno, California area. Schedule a free consultation today.