Appealing a Workers’ Compensation Denial

You Need a Workers’ Comp Legal Specialist

In California, the worker’s compensation process is extremely time sensitive. As a result, many claims are rushed and end up being denied for a variety of reasons. Luckily, you do have legal recourse to appeal the insurance company’s decision. Most people are filing a workers’ compensation claim because they’re suffering a loss of income and high medical costs. Since the stakes in these cases are so high, it’s critical to contact an experienced Southern California employment law attorney who can build an effective case for your claim.

At Malter Law Corporation, our Woodland Hills workers’ comp lawyer has more than 40 years of experience handling workers’ compensation claims and appeals. He previously worked as a workers’ compensation defense attorney, giving him unique insight into the inner workings of the insurance companies. Our firm can be contacted via phone 24 hours a day, 7 days a week, and we proudly represent workers in both English and Spanish.

Was your claim denied? Call Malter Law Corporation at (818) 839-2588 to appeal the insurer’s decision.

Why Was Your Claim Denied?

Workers’ compensation insurance is a business, and like any other business, their primary motivation is usually profit. Insurance providers have a team of adjusters on staff whose jobs involve investigating claims and looking for reasons to deny them or mitigate their value.

In California, workers’ compensation claims can be denied for a variety of reasons, including:

  • The injury did not happen while you were working
  • A doctor or healthcare provider claims you were not disabled from the injury
  • The injury was not reported in a timely fashion
  • Your injury was the result of a preexisting condition
  • There is no medical record of an industrial injury.
  • You reported the injury AFTER you were terminated.
  • You are an independent contractor and not an employee.

Not sure if you have a case? Contact us today for a free case evaluation.

How to Appeal the Decision

If you’re suffering from a debilitating injury or illness, a denial of your claim can leave you in a difficult financial situation. However, you do have options to appeal your claim.

Step One: Contact an Attorney

While it’s in your best interests to retain an experienced workers’ compensation attorney from the very start, it is particularly valuable to have legal counsel while you file your appeal. A lawyer can guide you through the appeals process, and understands how to craft an effective case on your behalf.

Step Two: Contact the Insurance Provider

This is another step that your attorney can handle for you. After a claim is denied, you should contact the insurance company to determine exactly why it was not approved. In some cases, they may only require a specific document that you didn’t provide. Your attorney can use this information to build a maximally effective appeal. You can also take this opportunity to ask the insurer to reconsider their decision, although that request is more likely to be taken seriously when made by an attorney.

Step Three: File a Formal Appeal

In California, you must file your formal appeal within one year of the date of injury or illness. For this reason, it is imperative to retain qualified legal counsel who can ensure everything is filed correctly and on time. Filing the appeal involves requesting that your case be heard by the Workers’ Comp Appeals Board. Generally, the issue in question is whether or not the injury or illness is compensable—meaning that is covered and eligible for workers’ compensation benefits. Your lawyer will need to compile a variety of evidence, including medical records, in order to build a solid case for your appeal.

Hurt At Work? Call Our Firm Today.

While California is a very employee-friendly state, the workers’ compensation claims process can be confusing and overwhelming. To secure the best results in your case, you should retain a qualified Woodland Hills workers’ comp lawyer before you even file your initial claim. Remember that insurance adjusters will look for any information that can be used to deny your claim, including medical history.

At Malter Law Corporation, our skilled attorney can advise you on the best course of action, and can help protect you from the insurer by determining which information should actually be shared. Our attorney has previously defended insurance companies in workers’ comp claims and now uses this experience to stand up for the rights of injured workers.

Don’t hesitate to pursue fair compensation for your workplace injury. Call our firm today for seasoned counsel.

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Woodland Hills Workers' Compensation Attorney