Workplace injuries interrupt your life. Even with workers’ compensation, most families will experience some financial struggles because workers’ comp pays lost wages at two-thirds of the rate of actual wages. However, workers’ comp should cover all your medical bills and related expenses, helping your family during your recovery period. In fact, most workers count on it to protect them when they have a workplace injury.
Having a valid workers’ comp claim denied is not just frustrating—it is disheartening. Being unable to work because of an injury, only to find out your employer’s insurer is denying your claim, can make you feel hopeless and leave you in a position where you cannot afford the medical care you need. A San Bernardino workers’ compensation appeals lawyer could help.
Employees Have a Limited Time to Appeal Denials
If an employee receives a denial and does not appeal it, the employee loses the right to pursue their claim. Calling the insurer to ask why the claim was denied does not begin an official appeals process. In fact, it could put a worker in a more difficult position in the appeals process since the insurance company is acting adversely to the employee’s interests at that time.
However, that may depend on the reason for the denial. Sometimes, insurers deny a claim because the employee failed to comply with the technical requirements of the claim process. An employee may be able to remedy the error and resubmit. However, insurers have no reason to tell applicants how to remedy the error. After all, they do not want to pay money for the claim. An applicant in San Bernardino may need a workers’ compensation appeals attorney to help them identify errors and provide guidance on how to fix them.
Common Reasons Insurers Deny Workers’ Comp Claims
One of the leading causes of denials is failing to report the illness or injury to the employer within 30 days of an injury or becoming aware of an illness. That is a non-negotiable qualification, though it will not always lead to denial. If an attorney can demonstrate there was a reason the employee did not file the claim within 30 days, they may have a successful appeal.
In addition to the 30-day deadline, employees have one year to file a workers’ comp claim. Not filing in time can prevent someone from being eligible for the insurance. It almost always results in an automatic denial of an employee’s claim. However, the law provides exceptions to the one-year rule. If an employer misleads an employee about workers’ compensation laws, it will toll the statute of limitations for a workers’ comp claim. An employee does not have to show misconduct by the employer—even an injured employee’s ignorance of how to file a claim may be sufficient to extend the filing deadline.
Failing to get proper medical care is another reason insurers deny workers’ comp claims. Some workers will hesitate to get medical care because of the associated costs. Others may not realize the injury was severe enough to require care. Employees should get prompt medical care after a workplace injury. A workers’ compensation appeals lawyer in San Bernardino could also use testimony from medical experts to show that the injury is real.
Another common problem is when the initial physician’s medical report conflicts with the accident report. However, some symptoms can develop over time, which means that they can be worse than the initial symptoms. It is also easy for laypeople to misunderstand a medical diagnosis. Having the guidance of a lawyer could help employees avoid these pitfalls.
Talk to a San Bernardino Workers’ Compensation Appeals Attorney
It is not unusual for insurers to deny valid workers’ compensation claims. You may be tempted to give up your claim, but you should not. You do not have to handle the appeals process on your own. Hand the worry and stress to a San Bernardino workers’ compensation appeals lawyer instead. A lawyer could identify why the insurer denied your application, gather evidence to support your claim, and follow up at every step of the appeals process. Schedule a consultation to learn more.
(909) 885-1620