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What if my workers' compensation claim is denied?

When you suffer an injury on the job, you might think that you simply need to report the injury, file a claim and receive treatment for your injury. However, in some cases, a claims administrator may not approve your treatment. Workers' compensation does cover employee injuries to keep the employer from fielding too many lawsuits, but not every claim is automatically approved. If a claim administrator believes your claim does not warrant treatment, it may get denied. This may create tensions around how you'll recover from your injury and who will pay for the costs of that recovery.

If you need immediate medical care, you can request that your claims administrator approve the treatment temporarily while you wait to hear about the overall claim. This can grant you the treatment you need while giving you a little more time to sort out the logistics.

If you cannot get the approval, you can obtain treatment under your own insurance and inform your insurer that they should request reimbursement from the workers' compensation provider. This adds some strength to your side, because your insurer can put some of their "muscle" behind your request to approve the treatment.

If you need immediate treatment but do not have any personal insurance, you can seek out treatment from a medical care provider who will perform services without being paid up front. Once you've met your immediate care needs, you can continue to negotiate the claim.

These circumstances can be especially frustrating. The good news is that you don't need to do this alone. An experienced attorney can help you fight for fair treatment and ensure that you do not suffer under unfair claim denial from a workplace injury.

Source: State of California, Department of Industrial Relations, "Chapter 3. Medical Care," accessed Aug. 04, 2017

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Making a false or fraudulent workers’ compensation claim is a felony subject to 5 years in prison or up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine.

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