It should be a straightforward process. You were hurt at work, reported it and now your medical care and lost wages should be covered.
Therefore, it’s frustrating and confusing when your claim is denied. It’s not uncommon for claims to be rejected, but oftentimes those reasons can be challenged or corrected. Understanding the reason behind the denial is the first step toward figuring out what to do next.
Medical evidence is essential
One of the most common issues with workers’ comp claims is late reporting. Injured workers are expected to report a workplace injury within 30 days. Waiting too long can raise questions about whether the injury occurred at work. And while the deadline is 30 days, it’s best if you report your injury immediately, even if it seems minor.
Lack of medical evidence is another major factor. If your medical records don’t clearly connect your injury to your job duties, the claim may be denied.
Along those same lines, inconsistencies can also lead to claim denial. If what you reported to your employer doesn’t match what’s in your medical records, or if your description of the injury changes over time, the insurer may question your credibility.
In some cases, the employer may dispute the claim or argue that the injury happened outside of work.
However, a denial doesn’t necessarily mean your case is over. The insurance company may refuse to provide benefits voluntarily, but it doesn’t mean you’ve lost your right to pursue workers’ compensation. You can challenge the decision and present evidence supporting your claim.
In fact, medical documentation often becomes the deciding factor. It’s important that the treating physician clearly understands:
- How your job duties are performed
- When your symptoms started
- How has your condition progressed
The stronger the connection between your work and injury, the better your chances of overcoming the denial.
Challenging a workers’ comp denial can become complex. A legal representative can help gather medical evidence, prepare your case and represent you before the California Workers’ Compensation Appeals Board. Their assistance can make a meaningful difference in protecting your rights and getting the benefits you’re entitled to.
