Many Americans take pride in their work, performing their jobs to the best of their ability every day. These people trust that their employers have taken measures to keep them safe while performing work. Among these protections is workers’ compensation insurance, which covers an employee’s medical bills when they suffer a work injury.
According to the National Safety Council, a workplace injury occurs every seven seconds. Many of those injured employees will require medical care and file a claim with their employer. Though insurance companies only deny 7% of workers’ compensation claims, that leaves nearly 200,000 people with medical bills they cannot pay. These people may find success appealing the denied claim.
Appeal a denied claim in 5 steps
The Division of Workers’ Compensation (DWC) in California may deny a claim for various reasons. Since the burden of proof is on the injured party, many denied claims stem from a lack of evidence. Following these five appeal steps can help workers make their case and secure the coverage they need:
- Find the right lawyer: Most appeals processes require stacks of legal paperwork and facilitating communication between government organizations. A lawyer familiar with California’s workers’ compensation law can collect all the necessary paperwork and submit it without errors.
- File the appeal: Injured workers must first file an Application for Adjudication of Claim with the local DWC.
- File a hearing declaration: The appellant must then file a Declaration of Readiness to Proceed so the court will schedule the hearing.
- Settle or go to trial: The insurance adjuster who denied the claim will attend the hearing to make their case and perhaps offer a settlement. If a trial is unavoidable, the appellant must provide documents that explain the dispute and list evidence and witnesses.
- Attend the trial: A different judge will oversee the actual trial, hearing both sides and reviewing evidence. They will issue their ruling within 90 days.
The judge may not overturn the denial. In that case, appellants can petition the court to retry the appeal. An attorney can provide other options as well.
Workers’ compensation is a right
Many workers have found success appealing a denied claim with the right legal help. A local attorney familiar with California’s workers’ compensation law can help employees secure the coverage they deserve.