San Diego Denied Workers’ Compensation Claim Attorneys

Helping Injured Workers Appeal Denied Workers’ Comp Claims

Please note: Banker’s Hill Law Firm handles denied workers’ compensation claims, including denied disability and death benefits within the workers’ comp system. We do not practice employment law and cannot assist with related workplace disputes such as wrongful termination, discrimination, harassment, or unpaid wages.

Was your workers’ compensation claim denied even though you were hurt on the job? A denial is not the final word. If you have not filed yet, our San Diego workers’ compensation lawyers can handle the claim from the start. Our firm acts as your denied workers’ compensation claim attorney, challenging the insurer’s decision before the Workers’ Compensation Appeals Board (WCAB) and fighting for the medical care and wage-replacement benefits you are owed.

If an insurer is denying your workers’ comp claim in San Diego, the steps you take in the first weeks matter, because deadlines are short and evidence fades. Whether you were hurt in a warehouse, on the road, or on a job site, where our San Diego construction accident attorneys handle both the comp claim and any third-party case, we can review your denial letter at no cost.

Why Are Workers’ Comp Claims Denied in San Diego?

Make no mistake, your employer’s insurance company will look for any excuse to deny your workers’ compensation claim, which means even a minor oversight can lead to a denial.

Some of the most common reasons workers’ comp benefits are denied include the following:

• You didn’t report your injury to your employer right away
• You missed a deadline for filing your workers’ compensation claim
• Your injury wasn’t witnessed by anyone else in your workplace
• There is a discrepancy between your accident report and your medical records
• You filed your workers’ compensation claim after you were fired or laid off
• You refused to give the workers’ comp insurer a recorded statement or refused to sign medical authorizations
• The insurer claims the injury is not work-related or that your condition existed before the job

The denial letter should explain the reason. Many denials can be challenged with better medical evidence, witness statements, or proof that the reporting and filing deadlines were met.

How to Appeal a Denied Workers’ Comp Claim in California

When a workers’ compensation claim or a request for treatment is denied, the dispute does not go through your personal health plan. It is handled within the workers’ compensation system, and the path depends on what was denied.

Denied Claims: The Workers’ Compensation Appeals Board

If the insurer denies your claim entirely, for example by saying the injury did not happen at work, you can challenge the denial by filing an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board (WCAB). A workers’ compensation judge then decides the dispute.

Medical disputes in a denied claim are usually resolved through a report from a qualified medical evaluator (QME), and the judge weighs that evidence. If you disagree with the judge’s decision, a petition for reconsideration is generally due within 20 days of service, or 25 days if the decision was mailed (Labor Code § 5903).

Denied Treatment: Utilization Review

If your claim is accepted but the insurer denies or modifies a treatment your doctor requested, that decision is made through Utilization Review (UR). A UR denial must be in writing and must explain how to challenge it.

Independent Medical Review and Medical Necessity

You may request an Independent Medical Review (IMR) of a UR denial, generally within 30 days after the decision is served (Labor Code § 4610.5). An independent physician reviews whether the treatment is medically necessary, and an IMR decision in your favor overturns the denial.

Deadlines After a Workers’ Comp Denial

• Report the injury to your employer within 30 days (Labor Code § 5400).
• File your claim generally within one year of the injury (Labor Code § 5405).
• Request Independent Medical Review generally within 30 days after a Utilization Review decision is served (Labor Code § 4610.5).
• Petition for reconsideration generally within 20 days of service of the judge’s decision, or 25 days if it was mailed (Labor Code § 5903).

Because these clocks are short, talk with a denied workers’ compensation claim lawyer as soon as you receive a denial.

Penalties for Unreasonable Delay or Denial

California holds workers’ comp insurers to a standard of reasonableness. Under Labor Code § 5814, when a payment of compensation is unreasonably delayed or refused, the amount of that payment can be increased by up to 25 percent or $10,000, whichever is less. Separate automatic increases apply to late disability payments under Labor Code § 4650.

We review the claim file for signs of unreasonable delay, such as shifting reasons for a denial, ignored medical reports, or requests for information the insurer already has, and we pursue penalties when the insurer acts unreasonably.

Denied Workers’ Comp Death Benefits

When a worker dies from a job-related injury or illness, dependents may be entitled to workers’ compensation death benefits. These claims are often denied over documentation problems, disputes about whether a family member qualifies as a dependent, or arguments that the death was not work-related.

We can challenge a denied death benefit claim through the same WCAB process. Learn more about workers’ compensation death benefits in California, including who qualifies and what may be available.

Our San Diego Attorneys: Highly Skilled and Experienced in Denied Claims

Our team has years of experience in handling denied workers’ comp claims, including death benefits. We understand the nuances of Utilization Review, Independent Medical Review, and hearings before the Workers’ Compensation Appeals Board. We are committed to helping you navigate these complex processes to achieve the best possible outcome.

Avoid Setbacks and Pitfalls

With our assistance, you can avoid common mistakes that lead to denials, ensuring that your claim is handled accurately and efficiently. Our experience with denied claims and our understanding of insurance and workers’ compensation requirements mean we’re perfectly positioned to help you.

Frequently Asked Questions: Denied Workers’ Comp Claims

Schedule a Case Evaluation with Our San Diego Workers’ Comp Denial Lawyers Today

If your workers’ compensation claim was denied, contact our San Diego law firm to discuss your case. Our San Diego denied benefits lawyers can review the denial letter, explain your options, and file the appeal.

It’s natural to feel overwhelmed when an insurance company denies your claim, but a denial is not the end of the road. There are several ways to challenge the decision and pursue the benefits you need.

Our legal team has served clients in San Diego County, Riverside County, Orange County, and Los Angeles County for more than 35 years, and we are proud to help injured workers in our community.

If your workers’ comp claim or death benefits were denied, don’t navigate this process alone. Contact us at (619) 230-0330 or via WhatsApp, and let us guide you through every step.