How to Appeal a Denial of Your Glendale Workers’ Compensation Claim

claim denied

Workers’ compensation is a big help for covering medical expenses and lost wages when you sustain work-related injuries. However, what happens if your employer’s insurance carrier denies your workers’ comp claim?

Does that mean you can’t receive benefits?

Fortunately, you can still reverse the insurer’s decision by appealing against your claim denial. You only need to know the appeal process and hire the best Glendale workers’ compensation lawyer to guide you.

Why Insurance Providers Deny Workers’ Compensation Claims

auto insurance claim

Employers get workers’ comp insurance to cover compensations when employees claim benefits. However, insurance providers sometimes deny a claim when the claimant doesn’t qualify for the coverage.

Here are some factors that can push an insurer to deny an employee from claiming workers’ compensation:

  • The injury isn’t work-related, which means your injuries didn’t result from work activities.
  • Being intoxicated during the accident caused your injuries.
  • The injury resulted from intentional self-harm or a physical altercation with another person.
  • You didn’t follow workplace safety protocols while engaging in dangerous activities.
  • You have a minor injury, and you don’t need treatment or a few days off from work.

Aside from these legitimate reasons, insurers also deny compensation claims to get away from financial liabilities. That is because they are businesses. And they want to minimize the amount they release for compensation claims.

That’s when you must appeal a denial of your compensation claim to get the rightful benefits.

Steps for Appealing a Denial of Your Workers’ Compensation Claim

Set a hearing with the Workers’ Comp Appeals Board if you think your employer’s insurer has become unreasonable when denying your claim. Here are the steps to follow:

1. Hire a Professional Workers’ Compensation Attorney in Glendale

attorney

Having an attorney can increase your chances of getting fruitful results from your appeal. They can point you to the correct processes, prepare you before a hearing, and defend you in court.

2. File an Application for Adjudication of Claim.

Filing an Adjudication of Claim officially begins your workers’ compensation case. You will also get a workers’ comp case number on this step.

3. File a Declaration of Readiness to Proceed.

Next, file a Declaration of Readiness to Proceed or DOR to request a hearing scheduled in the WCAB court.

Ask your lawyer for help when filing this form. You may need to clarify some important points with your legal representative while filling in the document.

4. Attend a Priority Conference

priority conference

Priority conference is an expedited hearing to speed up your appeal. Here the insurer can deny or accept your claim. And you can proceed to the pre-trial conference if necessary.

However, remember the insurer’s reason for denying your claim in the priority conference and indicate it in your DOR form.

For example, the insurer may have denied your claim because they concluded that your injuries weren’t related to work activities. You must then check the “Arose out of Employment” or AOE box in the DOR form.

The insurance carrier may also claim that your injuries occurred outside the time, date, and place of work. In such a case, check the “course of your employment” or COE box in the DOR.

5. Attend Pre-Trial Conference

pretrial conference

The pre-trial conference is an informal hearing presided over by a WCAB judge. Here, the judge will listen to both you and the insurance provider before settling the case. If both parties can’t reach an agreement, the judge will set it for trial in court.

However, the judge can give time to gather evidence to support your claim, which can help settle matters without reaching a higher court.

Appeal a Workers’ Comp Denial with the Best Lawyer

Being denied a workers’ comp insurance provider is a worry, but you can still reverse their decision and get the compensation you deserve. So, hire a professional Glendale workers’ compensation lawyer and start the appealing process immediately.

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