Lawyers

Denial and Delay of Claims

Work Injury Lawyers Representing Employees in Orange County

If you suffered an injury or illness that you believe was caused by an accident or condition in your workplace, you may be entitled to workers’ compensation benefits. Recovering the benefits that you are owed can be a complicated process, and failing to present the evidence needed in support of your claim can result in a delay in receiving benefits or a denial of your claim altogether. If you have faced a denial or delay of a claim, it is essential to retain an attorney who has experience in pursuing California workers’ compensation claims. At the Law Office of Joseph Richards, our Orange County workers’ compensation attorneys are adept at gathering the evidence needed to recover workers’ compensation benefits.

Delay of Claims

The California Labor Code sets forth strict timelines for filing and evaluating workers’ compensation claims. First, an injured worker must generally provide written notice of injury or illness to the employer within 30 days of when it occurred or began. An employer is then obligated to provide a workers’ compensation claim form, which in injured worker must fill out and return to the employer. An employer’s workers’ compensation insurance carrier then has 90 days from the time that the injured worker returns the form to accept or deny liability for a claim. While many claims are approved immediately, claim approval may be delayed if the insurance company sees a need to conduct an investigation into the facts and circumstances surrounding how an injury or illness occurred. As a result, it is important to be as thorough and detailed as possible when filing an initial claim to prevent a delay due to any ambiguity as to the cause of an injury or illness.

It is important to note that while a workers’ compensation claim is pending, injured workers are entitled to benefits for medical care within one day of when a claim is submitted. The cost of medical care will be covered up to $10,000 until the time that a claim is approved or denied. If a claim is neither explicitly approved nor denied after the 90 days have elapsed, under California law, liability for a claimed injury may be presumed admitted.

Dealing With a Denial of a Workers’ Compensation Claim

If liability for a claim is denied, the injured worker may receive a Notice of Denial letter from the employer or their workers’ compensation insurance carrier. An injured worker generally has one year from the date of injury or the last date on which the worker received medical benefits to appeal a denial. First, an injured worker must file an application for adjudication of claim, which will open a case with the California Workers’ Compensation Appeals Board. Then, when an injured worker is ready to proceed before a judge, the worker will will file a declaration of readiness to proceed, attaching relevant medical records and documentation regarding the claim.

A mandatory settlement conference may be scheduled, during which an employer’s workers’ compensation insurance company and the injured worker may discuss the claim with a judge, who may generally try to facilitate a settlement agreement. If no settlement agreement is reached, a hearing may be held before the judge, in which each party may present evidence and arguments regarding their position. Following the hearing, the judge may issue a decision regarding a claim within about 90 days. If the judge does not rule in an injured worker’s favor, the injured worker may appeal a decision by filing a petition for reconsideration within 20 days. The Workers’ Compensation Appeals Board may determine whether to accept or deny the petition. If reconsideration is granted, the Board may then issue a decision on the previous ruling. If the ruling of the Workers’ Compensation Appeals Board is unfavorable, an injured worker may then file a petition for appeal from an unfavorable decision with the California Court of Appeals.

The process of appealing a denial of a workers’ compensation claim is extremely complex, and a failure to follow the proper process with each step may result in the loss of rights to recover benefits. Therefore, whether you have faced a denial or delay of a claim, you should seek the assistance of a skilled workers’ compensation attorney to discuss the merits of an appeal.

Schedule a Consultation With an Orange County Attorney Following a Work Injury

If you are unable to earn an income following a work-related injury or illness, such as a head injury or a back injury, a denial or delay of your claim can cause unnecessary financial hardships. The experienced workers’ compensation lawyers at the Law Office of Joseph Richards work diligently to help present the information necessary to ensure that injured workers’ claims are not delayed. We also help dispute denials of workers’ compensation claims. We frequently represent people seeking workers’ compensation benefits in Santa Ana, Costa Mesa, Anaheim, Irvine, Moreno Valley, Corona, Temecula, El Centro, Long Beach, San Bernardino, Fontana, Rancho Cucamonga, and San Diego, as well as other cities in Orange County and Riverside, Imperial, Los Angeles, San Bernardino, the Inland Empire, and San Diego Counties. Contact us to schedule a consultation at (844) 562-2667 or via our online form.

Client Reviews
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