Worker’s Compensation

How to react in case of denied worker’s compensation claim

Employers in most states have to provide workers’ compensation insurance for their employees in order to assure coverage of injuries or accidents at the workplace. Although there is a chance for the worker’s compensation claim to be declined, fortunately, there are a lot of options inclusive of an appeal through the state’s board of workers’ compensation. 

The successful outcome of the appeal depends on numerous factors. The key factor is the underlying reason for the claim rejection. Even though legislation varies from state to state, this doesn’t mean that you are not entitled to an appeal. If you are a resident of Orange County, CA, you should contact a workers’ compensation claim lawyer and get informed about the ways in which you can get a denied claim back on track. 

Reasons for workers’ compensation claim denial in Orange County, CA

One of the first steps that you should take if your workers’ compensation claim has been denied is to determine the reason for denial which should be stated in the denial letter. You should consult an experienced attorney in Orange County, CA to establish whether the cause of the denial was not meeting the eligibility criteria or an error occurred. 

Your workers’ compensation claim may suffer a setback for one of the following reasons:

  • Not reporting the injury on time: You need to provide your employer with the written report of the injury within a few days. 
  • Failing to file the claim in time: The initial worker’s compensation claim has to be filed within 30 to 90 days of the injury in most states.
  • Employer’s dispute of the claim: Your employer can disqualify your claim if the accident or injury happened outside of the office.
  • The injury doesn’t make you eligible for compensation: This refers to injuries that are hard to prove, typically the ones that are stress-related.
  • Failing to seek medical treatment: Seeking medical treatment is a prerequisite for receiving workers’ compensation benefits. If you had a slight injury that did not require medical attention or if you were negligent and did not seek medical treatment at the right time, leading to further complications, you will not be able to receive benefits. 
  • Not providing substantial evidence to prove the injury is work-related: One way to provide compelling evidence that the injury was work-related is to get a medical exam. 

Appeal process for workers’ compensation claim

The denial letter contains the reason for denial and a deadline for filing an appeal. However, before you take any further action and file an appeal you should talk with your employer and try to settle any disagreements or misunderstandings. It’s also advisable to consult a competent workers’ compensation lawyer in Orange County, CA, as appealing the denied claim can be a lengthy and complex process.


What happens to medical bills when workers comp is denied?

If a workers’ comp claim is denied, under workers’ compensation PA, the person who files a claim is responsible for the costs of medical treatment. Since medical care in Orange County, CA, and beyond is costly, denial of medical benefits can prevent people from getting the care that they need.

How do I appeal a workers’ comp denial in California?

In case of a refused claim you should hire a committed lawyer in Orange County, CA, to file a claim petition on your behalf. This way a judge will determine if your injury was work-related.

How often do workers’ comp cases go to trial?

According to estimation, less than 5% of workers’ compensation claims go to trial. The majority of cases are either uncontested, settled out of court, or settled through mediation or arbitration. The number of cases that go to trial is relative as in some states this includes administrative hearings, whereas in others it includes a trial heard in court.

How long does a workers’ comp case take to settle in California?

Most workers’ compensation cases in Orange County and other parts of California take 30 days to settle. Ideally, the workers’ compensation insurance company should process and approve the claim immediately. You also may need to appear before a judge in an informal hearing.

Who are the go-to attorneys for denied work comp claims in Orange County, CA?

If you need qualified and assertive workers’ compensation lawyers in Orange County, CA to help you with a denied claim, you can count on the Worker’s Compensation Attorney Group. We will ensure that your rights are protected. Our lawyers are also proficient in processing delayed cases. We also thrive in dealing with denied cases.

Explore Bolsa Chica Ecological Reserve or visit the Huntington Beach International Surfing Museum and leave dealing with a denied workers’ comp claim in our capable hands. We are at your disposal for a free consultation via phone, video call, or in person, with no strings attached. If you prefer keeping a safe distance you can sign up via DocuSign and we will start working on your case promptly!