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Why are some workers' compensation claims denied?

Aside from suffering a workplace injury in the first place, receiving notice that your workers' compensation claim was denied is one of the most frustrating events you can experience. You are already suffering and may be unable to work so the benefits you would receive from your claim are much-needed. Unfortunately, claim denials can and do happen.

Did you know that you can appeal a denied claim? In fact, it is your right to do so. However, the first thing you should do is to learn why your claim was unsuccessful. Below you will find some of the most common reasons for a claim denial.

  • Delayed reporting: In most states, you must report your injury to your employer right away. Failure to do so could result in denial.
  • Employer dispute: If your employer claims your injury occurred outside of work hours, you could face a claim denial.
  • Delayed filing: By waiting too late to file a claim, your efforts might be unsuccessful. This is why it is crucial to report the injury and file the claim right away.
  • No medical treatment: Nearly all workers' compensation claims require supporting documentation that the injury required medical attention. Be sure to see a doctor, and get a copy of your records.
  • Noncompensable injury: Some injuries like stress or mental issues are hard to prove. Fortunately, California looks kindly on stress-related conditions, but you still need to be able to prove your claim.

In order for you to recover from your injuries and return to work in good condition, you need the benefits workers' compensation provides. It is unwise to give up when you receive a claim denial. A better option might be to take your case to a workers' compensation attorney to find out if you have a good chance of appealing this decision and getting the benefits you need.

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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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