Denied Workers' Compensation Claim

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How to File a Workers' Compensation Appeal

Common Grounds for Denial of Claims

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Facing Denied Benefits? Let Us Assist You in Initiating an Appeal - Call (818) 477-0773

 

Steps for filing a workers' compensation appeal

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• Submit the Appeal Form: To start, fill out the official Application for Adjudication of Claim form. This form should be submitted to the local Division of Workers' Compensation (DWC) office in your county. The claims administrator will also receive a copy of this form.

• Get Your Case Number: After the DWC office receives your application, they will acknowledge it and give you a unique case number. This number should be used on all the documents related to your appeal.

• Ask for a Hearing: Complete a Declaration of Readiness to Proceed, which is your way of asking for a hearing in front of a judge. This hearing is called a mandatory settlement conference (MSC). During the MSC, the judge will review your case and aim to help you and the claims administrator come to an agreement.

• Participate in the MSC: Attend the mandatory settlement conference on the specified date. Present your case to the judge and have discussions with the claims administrator to explore if you can reach a settlement.

• Schedule a Trial: If you don't reach an agreement during the MSC, the next step is setting up a trial. In the trial, both you and the other party will present your arguments and evidence to the judge.

• Judge's Decision: After the trial, the judge will carefully assess the evidence, arguments, and legal aspects. The judge will then create a written decision, which will be sent to you by mail.

 

It's important to mention that having legal representation can be really helpful during this process, especially due to its complexity. If you're having difficulties with your appeal, you can seek advice from experienced workers' compensation attorneys who can guide you through the procedures and ensure you know your rights.

 

If you'd like assistance, feel free to contact our workers' compensation attorneys at (818) 477-0773. We offer initial consultations to discuss your particular situation.

 

Common Grounds for Denial of Claims

Denials of workers' compensation claims can occur for various reasons, but the most prevalent ones include:

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• Delayed Reporting: If an injury or illness isn't reported promptly to the employer, it can lead to doubts about the connection between the incident and the workplace.

• Pre-existing Condition: If the claimant had a pre-existing medical condition that could be responsible for the injury, the connection to the workplace might be challenged.

• Lack of Witnesses: In cases without witnesses to corroborate the incident, it can be harder to establish that the injury occurred at work.

• Employment Status: Disputes can arise if the employer argues that the claimant was not an employee at the time of the incident.

• Injury Not Work-Related: If it's believed that the injury didn't happen during the course of work or was not related to work activities, the claim might be denied.

• Missed Filing Deadline: Failing to submit the claim within the specified time frame can result in denial.

• Insufficient Medical Evidence: The claim could be contested if the medical records do not clearly link the injury to the workplace.

• Allegations of Fraud: The claim might be disputed if there's suspicion that the claimant is exaggerating or falsifying the injury.

• Disputed Medical Opinion: If there's a disagreement between the medical professionals about the cause and severity of the injury, it can lead to disputes.

• Failure to Follow Procedures: Not adhering to the required reporting or medical treatment procedures can result in claim denial.

 

Please consult with an Experienced Los Angeles Workers' Compensation Attorney Today: At State Law Firm, our competent attorneys specializing in workers' compensation can discuss your claim and offer advice on whether pursuing an appeal is wise. Feel free to contact us to learn about your available options.

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