Workers' Compensation Appeals
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If you were injured at the workplace or in conjunction with your work duties, then you likely filed a workers' compensation claim. Unfortunately, many legitimate claims that are filed are denied by claims administrators. When this happens, you should not give up hope. With the right legal assistance, you can file a successful claim for appeal. Many people disagree with the decisions made by their claims administrator, and that is where our firm can step in.
By speaking with a Santa Clarita personal injury lawyer from our firm, you can learn the steps you need to take to appeal your claim denial and ask for reconsideration.
What are some reasons claims are denied?
Injury not covered by workers' comp
Failed to meet filing deadlines
Did not supply the necessary documentation in claim
Although your claim may have been denied, you have rights as a worker. Injured workers have the right to adequate medical treatment, disability payments, returning to the job after recovery and also the right to resolve a disagreement regarding a workers' compensation claim. If you are in dispute about your denied claim or any aspect of your claim, you may be able to file a complaint with the California Division of Workers' Compensation (DWC).
Common complaints the DWC receives from workers:
- Doctor failed to adequately examine the worker
- Doctor was not qualified to determine benefits
- The process used to determine benefits was wrong
- Benefits were allotted inaccurately by the claims administrator
To resolve these types of complaints, the DWC will use their medical unit, a utilization review investigation or the claims adjudication unit of the appeals board. There are also various petitions, rather than complaints, that workers can file with the Workers' Compensation Appeals Board (WCAB). These include petitions for reconsideration, petitions for removal and petitions for writ of review.
On the other side of the spectrum, your claims administration may come to disagree about an aspect of your claim. This can happen for a number of reasons, but often because the claims administrator is suspicious about the validity of the claim. You may be asked to be medically evaluated by a qualified medical evaluator (QME) or an agreed medical evaluator (AME).
Filing a Workers' Compensation Case
If you would like to object to the decision made regarding your workers' compensation claim, then you will need to file your case at the workers' compensation division office nearest you. A Santa Clarita injury lawyer from our firm can assist you in filing this type of claim. The closest office is located in Van Nuys at 6150 Van Nuys Boulevard, Suite 105. These offices are trial courts, and your case will be heard by a judge, but not before a jury.
Before you can be able to file a case, you must complete the necessary paperwork. This is called the Application for Adjudication of Claim. Once this is filed and received, you can file a Declaration of Readiness to Proceed. While this process can seem complicated, there is help to be found. At The Law Offices of Gerald L. Marcus, we are skilled in dealing with workplace accidents and procuring the necessary compensation by way of workers' comp insurance.
Your Santa Clarita Personal Injury Attorneys
If you were injured at work, but are struggling to lay hold of the workers' compensation benefits that you rightfully deserve, get in touch with our firm as soon as possible! These types of cases are time sensitive, which means that you will likely benefit from involving a lawyer early on in your case.
For an evaluation, contact our Santa Clarita workers' compensation lawyers.
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