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Why would a workers' compensation claim in California fail?

It is safe to say that most workers in California find comfort in knowing that workers' compensation benefits are available after a workplace accident. However, just because an employer complies with the law to provide workers' compensation coverage does not necessarily guarantee that a claim will succeed.

Workers' compensation claims can fail for a wide variety of reasons. As such, it is wise for employees in the state to learn about the requirements when filing a claim. Making even a small mistake can delay or invalidate your benefits. The following sections contain examples of several barriers to successful claims:

Reporting deadlines: If you wait too long to report the injury to your superiors, you could receive a denial. The deadline for reporting an injury ranges from 30 to 90 days, which is why it is important to report all incidents immediately. This is so even if an injury does not manifest right away.

Filing deadlines: Injured workers typically have one to three years in which to file a workers' compensation claim. Filing outside of the deadlines may make your claim invalid.

Medical requirements: When you report the injury and file your claim on time, you must still meet certain requirements. For example, if you fail to appear for scheduled doctor appointments or do not comply with the recommended treatment, you might receive a claim denial.

Injury requirements: If your boss or a workers' compensation claims adjuster cannot link the injury to your work activities, your claim is at risk of denial. Denial could also occur if your injuries are not severe enough to qualify for compensation.

Fortunately, you have legal options in the wake a claim denial. Consider discussing your case with an experienced lawyer if you wish to appeal the decision.

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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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