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What happens after a workers’ compensation claim is denied?

On Behalf of | Aug 20, 2024 | Workplace Injuries |

Employees in California typically have access to financial protection in the wake of job-related injuries. Specifically, they may be eligible for workers’ compensation benefits when they have an injury or illness directly caused by their employment. Employers have to carry coverage to protect against direct liability for employee injuries and illnesses.

The California workers’ compensation program doesn’t just protect businesses from lawsuits. It also helps workers secure medical coverage for necessary treatment and disability benefits if they require a leave of absence from work. Employees have protection from financial devastation if they have medical challenges caused by their employment.

Sadly, not all workers have an easy path to benefits. Sometimes, when they apply, they receive a denial notice instead of an approval letter. Many people immediately panic after a denied benefits application. They don’t know how they can afford their care or recover from the interruption of their income.

What options does an employee have when they can’t get workers’ compensation benefits after sustaining an on-the-job injury?

Workers can request a hearing

The reason for denied workers’ compensation claims might be the lack of adequate evidence. There may be questions about whether someone actually requires a leave of absence or medical care because of their limited symptoms. Other times, the issue may be misconceptions about the origins of the injuries.

Those still hoping to obtain benefits can potentially secure benefits by attending a hearing in front of an administrative law judge. They have to file paperwork requesting the hearing and then prepare to convince the judge that they have a condition that makes workers’ compensation coverage necessary.

Thankfully, workers do not have to handle that process alone. They have the right to bring in outside legal representation to assist them throughout the claims process. An attorney can handle the paperwork required to request a hearing. They can educate a worker about their rights and what to expect during the hearing. They can also help gather evidence ranging from medical records to expert testimony.

With the right support, an employee facing an unfair denial of workers’ compensation benefits may be able to reverse the initial decision. Reacting in a timely fashion and obtaining the right support can both be crucial for successfully resolving a denied workers’ compensation claim.