Denied Workers Compensation Claim
Why Genuine Claims to Workers' Compensation Gets Denied
From January to July 2023, approximately 3,000 employees were denied workers’ compensation claim benefits in California. Legitimately injured and suffering employees routinely get workers’ comp denied by the following reasons:
- The injury or illness claim did not occur at work.
- The injury is a pre-existing condition.
- The insurance company doctor reports the injury is not work-related.
- The injury did not occur or is not as severe as claimed.
- The employer fired the employee, and in retaliation, the employee filed a claim.
However, these manufactured assertions are diversions to keep one away from the truth. The primary motivation behind a denied workers’ comp claim is simply money driven by big and powerful insurance companies.
Insurance Carriers Deny Your Workers' Compensation Claim
An employer’s workers’ compensation insurance company ultimately issues benefits for injured or ill employees. The insurer’s bottom line is generated by creating and ensuring revenue. The opposing insurance company is not principally committed to your complete interest.
Current Department Of Labor figures show that just over 35% of work comp claims are denied in California. Insurance carriers engage in the universal practice of denying or minimizing a claim. An inexperienced and vulnerable worker without qualified representation will often head into a complex trap to ultimately accept what follows.
Lockton Insurance Companies performed a work comp claims review several years ago. They discovered that denied workers’ compensation claims that went unchallenged were settled for 4 to 5 times less ($7,489) than from challenged claims with experienced representation ($36,991).
Work comp insurance carriers are able to save millions by withholding fair compensation from workers that did not know how to fight for their rights.
What to do with a Denied Workers' Compensation Claim
If you receive a denied workers’ compensation claim or delay letter, do not face this situation alone or settle. Immediately reach out to an experienced workers’ compensation lawyer. Book a consultation to know what your rights are. You may discover enough cause to go against your employer’s insurance carrier.
Thomas DeBenedetto & Associates - Workers' Compensation Attorney
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Workers' Comp Denied & Delayed Cases Accepted
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- Proceed to secure all available medical care despite your claim being denied or delayed. A designated doctor will document crucial medical evidence to litigate your claim and obtain benefits successfully.
- File an Application for Adjudication at the Workers Compensation Appeals Board (WCAB) in San Diego to preserve the Statute of Limitations to your claim. The WCAB will create a case number that we will use for any denied benefit court hearing.
- Assemble all previous medical and existing documentary evidence needed to convince a workers’ compensation judge that your injury or illness occurred on the job.
- Schedule a hearing request at the WCAB. At the hearing, the workers’ compensation carrier can accept the claim or go to trial.
Our experience has shown when faced with overwhelming and supporting medical evidence; the insurance carrier will concede and accept your claim.
In the alternative, they offer a settlement you deem acceptable.
If the denied work comp claim is not accepted or settled we will obtain a trial date, take testimony, and the Worker’s Compensation Judge will make a decision based on the testimony and the medical evidence presented.
Understand that during a delayed or denied work comp claim status, the workers’ compensation carrier will not pay you any wages if you cannot work. Tremendous financial stress can be created, which is partly their goal to maintain profit and end the claim. Our firm will seek all potential payments from other sources.
SDI and Denied Workers' Compensation Claim
State Disability, or SDI or EDD, often comes up in denied work comp claims discussions. SDI is not a workers’ compensation benefit. This is a separate benefit provided to all individuals who cannot work at their usual job because of injury or illness, whether work-related or not.
State Disability Insurance Compensation is often, though not always, paid at the same rate as your workers’ compensation benefits. State Disability will pursue reimbursement of payments they make to you from the workers’ compensation carrier. Our law office will attempt to secure these payment options.
In addition, we will refer you to a physician who will treat your injuries on a lien basis and can sign you up for these benefits. Keep our office advised on your actions.
Work Injury Attorney, Thomas DeBenedetto
Thomas DeBenedetto • Since 1992
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Successful Workers' Compensation Denied Claim Case Studies
Mr. A was an Arabic interpreter and role player who worked for a company that simulated war games. On a specific day during a simulated war, Mr. A was struck in the head and other areas of his body, causing a loss of consciousness. The most serious injury sustained was to Mr. A’s head, and this naturally was the body part that the workers’ compensation carrier denied. My office obtained many overwhelming medical evidence, including Qualified Medical Evaluations, deposition of physicians, and witness statements in anticipation of trial. The matter was trialed even though the Workers’ Compensation Carrier had no evidence to support their denial of the severe head injury. Approximately one month before the trial, I received a phone call from a new defense attorney who had replaced the first defense attorney. He conceded that the file had been mishandled and wished to engage in settlement discussions. The matter was settled before trial for $1,350,000. The injured worker never gave up, and neither did my office.
THE CASE OF MR. Q.
Mr. Q was a car salesman who, while on the job, was punched in the face by a fellow car salesman sustaining striking his head on concrete, causing a severe head injury that required emergent medical care and hospitalization. The workers’ Compensation carrier denied the claim and argued that Mr. Q was at fault for starting the fight. This is called the initial aggressor defense. My office, through subpoena, obtained an actual video of the fight, which demonstrated that Mr. Q. turned around and walked away and then was struck with a violent punch. Despite this video, the workers’ compensation carrier would not accept the claim, and it went to trial. The worker’s compensation Judge ruled in Mr. Q’s favor, and he received medical benefits, temporary disability, and retraining and ultimately received a $610,000.00 settlement.