Workers’ compensation is a no-fault system, meaning that if you get injured at your California workplace, you will more than likely receive benefits. Unlike in standard personal injury cases, you do not have to prove that your employer acted negligently for the insurer to award you compensation. That said, you may still receive a denial notice. If you did, you may wonder why. FindLaw explores the common reasons for a denial of workers’ comp benefits.
For many injured parties, timing is an issue. If you did not report your injury within the time frame California law specifies, you may have unwittingly forfeited your rights to workers’ compensation benefits. You must report your injury to your employer or supervisor in writing, typically within a couple of days of the incident. Another reason the insurer may have denied your claim is that you did not file it on time. Though state laws vary, you typically have between 30 and 90 days to file the claim.
Sometimes an insurer will deny a workers’ compensation claim because the employer disputes it. For instance, your employer may assert that your accident happened outside of work, or that it was the result of horseplay.
Another reason the insurer may have denied your claim is that your injury is not compensable. For instance, many states do not compensate individuals for stress-related injuries. California, however, does.
The insurer may also have denied your workers’ compensation claim if you did not receive medical treatment following the incident. In almost every worker’ compensation case, the insurer requires proof of injury.
Finally, the insurer may have denied your claim if you did not provide sufficient evidence that your injury is work-related. A thorough medical exam and additional evidence can help establish causation and support your claim.
This article is not meant to serve as legal advice. It is for educational purposes only.