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Workers Compensation Denied? Here’s What You Should Do

Workers compensation is a system that helps workers who get hurt on the job, but what should you do if you have your workers compensation denied?

There is a good news/bad news scenario for the economy. Market research analysts recently reported expected growth in the construction industry of nearly 3% in 2018.

From an economic perspective, this is good news. The only bad news to squeeze out of this is that, as more people become employed at a construction job site, the risk rises for construction accidents and injuries.

What Does Workers Compensation Cover?

Under California’s workers compensation law, each workers comp insurance covers:

  1. Medical Care: includes reasonable medical treatment to relieve injuries or illnesses due to the workplace injury or accident (depending on the insurance, you may be limited to specific doctors)
  2. Temporary Disability Benefits: includes payment during recovery time if incapable of returning the job immediately
  3. Permanent Disability Benefits: similarly, includes payments to the individual if they never fully recover
  4. Supplemental Job Displacement Benefits: given from the employer to pay for re-training if the individual never fully recovers, and doesn’t return back to work
  5. Death Benefits: payment to spouses, children, or dependents given a death on the job

When Is Workers Compensation Denied?

Once again, the claims process is incredibly complex. Even if an injury claim has been denied, that may not necessarily be the final word.

Many reasons given to justify a denial of a claim may be surrounded with a gray area. A legal professional will know the right strategy to illuminate this gray area in your favor. Don’t make the mistake of giving up too soon.

Although federal labor law requires employers to carry workmen’s compensation insurance to provide for employees injured on the job, the reality is that many claims for workers compensation are denied.

Filing a construction accident claim without the aid of construction accident law firms is complex. It is not uncommon for a single detail to result your workers compensation denied. These include:

  • Injured during work hours but not actually at the job site.
    • For example, a truck driver is injured while on the job but during a fuel stop. Does the employer’s workmen’s compensation pay or the owner of the gas station?
  • Failure to notify employer of injury within required time window.
    • This often occurs with injuries that are, at first, perceived as minor. An employee engages in self-care for a period of time, thinking a pulled muscle or twisted ankle will resolve itself. By the time they realize they have been seriously injured, it is too late to file a claim, so they receive workers compensation denied. Typically you have a 30 day window to tell your employer of your injury.+
  • Failure to determine injury was job-related.
    • This can also be related to the circumstance example in #2. When a claim is not made at the time of the injury, while still on the job, a workmen’s compensation insurance provider will question if the injury actually occurred on the job. The possibility of an injury occurring off-the-job, then reported as a work-related injury days later, can muddle up the clarity of a claim. Was the rotator cuff actually injured while working as a warehouse stocker or during a round of tennis?
  • Use of an non-approved medical provider.
    • Employer and insurance providers have the right to expect employees to use certain medical providers. Often, an employee is unaware of this stipulation. Once injured, a worker does what is natural. They visit their own doctor.
  • Injured while goofing around.
    • We all do it. We all joke around with co-workers we have developed a sense of camaraderie with. And sometimes this results in unexpected accidents.