What if my Workers’ Comp claim has been denied?

Published On: February 26th, 2019|By |

In the California workers’ compensation (“WC”) system, the WC defendant e.g., the WC insurance carrier or permissibly self-insured employer, is allowed to place your claim on delay status for up to 90 days from the date of the defendant’s receipt of your WC claim. Within this 90-day delay status period, the WC defendant is supposed to conduct a good faith preliminary investigation into the facts and circumstances surrounding your alleged work injury. Based on the WC defendant’s investigation, the WC defendant may accept your claim and begin or continue to authorize treatment and pay you workers’ compensation benefits. Alternatively, the WC defendant may send you a denial letter, denying your WC claim either in part, or in full.


My workers’ compensation claim has been denied in full. What does this mean?


Frequently, the WC defendant will deny your workers’ compensation claim in full. This means that the WC defendant disputes all liability for your alleged work injury and claims it owes you NOTHING. The WC defendant denies you sustained any injury arising out of the employment in the course of your employment (“AOE/COE”), and denies that it owes you any workers’ compensation benefits. 


How do I fight back if my WC claim has been denied?


If or when your workers’ compensation claim is denied, it is important that you have an advocate doctor(s) and attorney(s) on your side. They will fight back against the WC defendant’s full denial of liability. If the WC defendant refuses to settle and/or continues to deny responsibility for your WC claim, you may even need to litigate your claim in a trial on all issues with the WC judge at the Workers’ Compensation Appeals Board (“WCAB”).


While you are fighting  your case:  TTD, TPD and SDI and more…


If the workers’ compensation defendant is denying your claim, and/or is claiming it owes you no temporary total disability (“TTD”) and/or temporary partial disability (“TPD”), you may need to file for State Disability Insurance (“SDI”) benefits. While you fight your case, you can do this through the California Employment Development Department (“EDD”). Assuming you pay into EDD, SDI is good for up to one year. SDI is paid to you as a wage loss replacement benefit and is paid at approximately two-thirds of your average weekly wages (“AWW”), taking the highest average of your wages in a 4 quarter, 12 months period. In addition, you may need to look into other sources of potential wage replacement benefits through private short-term and/or long-term insurance; Social Security Disability Insurance (“SSDI”); union benefits provided under a collective bargaining agreement (“CBA”); and/or county assistance etc. To remain off work from an employer when you have a denied injury and/or denied body parts/medical condition, you may need to use your personal time under the Family Medical Leave Act (“FMLA”).


I need legal help with my denied workers’ comp claim…


If your case is denied, you should consult with an attorney that will be an advocate for you in your workers’ compensation case. Ford & Wallach offers a free consultation and will determine the best course of action that will protect your rights. Our workers compensation attorneys will fight for all of the benefits you are entitled to. Contact us by email or call 213.380.3140

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