Dealing with workers’ compensation claims can be stressful, especially if your claim is denied. Understanding the reasons for rejection can help you avoid common mistakes and better prepare your case.
Below are four issues that can make it difficult for you to make a successful claim:
1. Failing to report the injury promptly
One of the most common reasons for a claim denial in California is a delay in reporting the injury. Under California law, you must report a work-related injury to your employer within 30 days of the incident. If you fail to do so, you may lose your right to workers’ compensation benefits. Waiting too long can lead your employer or their insurance company to question whether the injury happened at work or if it was serious enough to report.
2. The injury didn’t happen at work
For a claim to be approved, the injury must have occurred while you were performing work duties. If the insurer believes the injury happened off-site or during personal time, they may reject the claim. Disputes can also arise if the injury occurred during a break, commute or at a company event.
3. Lack of medical evidence
Medical documentation is key to a successful claim. If there are no clear medical records linking your injury to your job, the insurer might say there’s not enough proof. Missing doctor visits, inconsistent statements or gaps in treatment can also raise red flags.
4. The claim was filed after leaving the job
Claims filed after quitting or being fired can be viewed with suspicion. Some insurers question the timing and argue that the injury wasn’t work-related. While it’s possible to file after leaving a job, doing so may lead to extra scrutiny.
If your account of the injury changes over time or doesn’t match what your employer or doctor reports, it can hurt your case. Insurers look for consistent information when reviewing a claim.
Having legal guidance can improve the chances of success in your case. If your claim has been denied, do not give up without a fight.
