What Happens if My Claim is Denied?

Learning that your workers’ compensation claim has been denied can bring about many worries and emotions. How will you pay your bills? Can you afford the medical care you need? Will you be able to return to work? It’s imperative to know that just because the claims adjuster denied your claim doesn’t mean you have no other options. You still have several legal options regarding your claim, and one of them is to pursue an appeal with a trusted El Monte workers compensation lawyer. Since many appeals are denied, it’s a good idea to have a seasoned workers’ comp appeals attorney help ensure your appeal is done the best way possible.

The Workers’ Comp Appeals Board Hearing

The first step in your appeal is to file an Application for Adjudication of Claim and then request a hearing before the Workers’ Comp Appeals Board (WCAB). Keep in mind that you’re appealing to this board, not the insurance company or your employer. The basis of your appeal is whether or not your claim is “compensable” — meaning if your injury should be covered under the workers’ compensation system. To request your hearing before a WCAB judge, you or your attorney must file a Declaration of Readiness to Proceed (DOR).

What is a Priority Conference?

Suppose your claim was denied because the insurance company didn’t agree that your injury or illness was caused during the course of your employment caused by your work activities. In that case, the WCAB judge will set an expedited conference date to resolve these issues quickly. Then you will know if your claim is accepted or denied based on this determination.

What is a Pre-Trial Conference?

If the determination is made that your claim is accepted because your illness or injury is work-related, your appeal can move on to the next step. A pre-trial conference can be scheduled as long as you or your attorney has submitted the Declaration of Readiness to Proceed form. You will receive a notice of hearing with the conference’s date, time, and location. During this conference, it’s the job of the workers’ comp judge to help process and potentially settle the issues over your claim.

The good news is that many disputes over workers’ comp claims are settled during the pre-trial conference, and the insurance company accepts the majority of reaching this stage.

If the conference isn’t successful at settling the issue, the judge will set the matter for trial. In some cases, the judge might decide that more information is needed before trial. If this happens in your case, the judge will initiate a discovery plan to gather evidence to help determine the issues in your case. They might also schedule a status conference to check on the available evidence.

Medical Examinations

If the insurance company denies your workers’ comp claim due to medical issues, it’s imperative that you see a doctor and have your injury or illness evaluated. If you aren’t satisfied with the evaluation your doctor provides, it’s your legal right to request an evaluation by a different doctor. Likewise, if the insurance company isn’t satisfied with the evaluation of your doctor, they can request that you obtain a medical evaluation by another doctor.

Increase Your Appeal’s Chances of Success by Hiring a Workers’ Comp Attorney

A workers’ compensation appeal isn’t an easy process. It’s crucial to have a legal professional on your side who has been through this before and knows what it takes to win an appeal. If your initial claim was denied, reach out to an experienced attorney for help before proceeding.