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Ghitterman, Ghitterman & Feld

Relentlessly Protecting California Workers' Rights Since 1956

Common Reasons for Workers' Compensation Denials and How to Appeal Them Successfully

Worker's Compensation

Workers' compensation is your right to claim as an employee if you suffer an injury or disease. Workers' compensation guarantees you receive medical benefits and wage replacement if your injury or illness requires time off work. Workers’ compensation is essential for any employee, especially those working in hazardous conditions. However, sometimes, claims get denied, and you might wonder what to do next.

1. Incomplete or Inaccurate Information

One of the most common reasons for a worker's compensation claim denial is inadequate information. The claims adjuster needs to verify your information since they assess how much compensation you can receive. Be sure to provide comprehensive medical documentation that shows your injury was work-related. If you receive medical attention for your injury, inform your doctor that the injury occurred in the workplace.

2. Late Reporting of the Injury

Another widespread reason for a denied claim is reporting your injury too late. When an employee gets injured at work, they must report it to their employer as soon as possible, usually within thirty days. By reporting the injury late, an employee might allow skepticism, doubt, or insurance adjusters to question the claim's authenticity.

3. Pre-existing Condition

Submitting a claim might be problematic if your injury arises from a pre-existing condition. It is crucial that when filling out forms or speaking to your doctor, you notify them if you are suffering from a pre-existing condition. By doing so, the workers' compensation insurance will review your claim more accurately and make informed decisions. Remember that even if the pre-existing condition exacerbated your injury, this would not diminish your worker compensation eligibility.

4. Employer Dispute

An employer may dispute a worker’s compensation claim if they think the accident was due to the employee's negligent behavior. Furthermore, if there are no credible witnesses or incomplete documentation, the employer may argue that the employee's injury did not occur at work. To support your claim, it's essential to gather any evidence of the incident, such as surveillance footage, eyewitness testimonials, and workplace safety records.

Workers’ Compensation Lawyers Serving California

If you or a loved one is facing the challenge of a workers' compensation denial in Santa Barbara, CA, remember that you don't have to face it alone. At Ghitterman, Ghitterman & Feld, we understand the intricacies of workers' compensation law and are dedicated to helping you secure the benefits you deserve. Our experienced attorneys will guide you through the appeals process, from gathering additional evidence to representing you at hearings. Don't let a denial be the end of the road. Contact us at (805) 243-2179 to discuss your case and explore your options for a successful appeal.

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