Maybe your doctor just informed you that the reduced lifting strength in your arms is a sign of carpal tunnel syndrome that you developed from gripping and using tools all day at work. Perhaps you fell from scaffolding while helping repair a building’s brickwork and broke your leg.
As an employee in California, you have the option of filing a workers’ compensation claim if you get hurt on the job or develop a medical condition as a result of your employment. Although some people think of workers’ compensation as automatic, getting benefits can sometimes be a difficult process.
After filing your claim, you might hear back from the insurance company and learn that they denied it. What can you do when you can’t get workers’ compensation benefits?
You have the right to challenge the decision
In California, state law includes protections for employees who need workers’ compensation but face a rejected claim. When the plan administrator for the insurance company responds to notify you that they have not approved you, you can challenge their determination.
You will need to file paperwork and prepare for a hearing in front of an administrative law judge. You have the right to hire an attorney to assist you with this process, which can reduce your personal stress levels and increase your chances of success.
Medical documentation can help you prove the severity of the condition to the judge, and evidence ranging from witness statements to incident reports can help affirm that the condition relates to your employment. Many workers successfully get benefits after a hearing in front of an administrative law judge. However, there are further options available, including an appeal if the judge does not rule in a claimant’s favor.
There are options
Sometimes, the reason company denies a workers’ compensation claim is that they believe the employee got hurt outside of work. Undergoing an examination arranged by the state could help you prove that your condition is a result of your job. Other times, the company may not believe that the injury is serious enough to affect your job functions or may deny a claim based on a paperwork technicality.
Reviewing the paperwork to determine what caused the denial of your workers’ compensation claim will help you prepare for an appeal.