Denial of Workers Compensation

Helping You Fight Workers’ Compensation Denial in California

Fresno attorneys protecting the rights of injured workers

When you are injured and in need of financial assistance, it can be stressful to have your workers’ compensation claim denied. It is important to understand that employers and insurance companies routinely fight claims in the hopes that you will give up. You can find relief with an experienced workers’ compensation lawyer at Perez, Williams, Medina & Rodriguez, LLP. Partnering with us to pursue your claim shows that you are not going to back down until you recover the compensation you deserve.

Why your claims are denied

Claims administrators deny workers’ compensation claims based on legal reasons or factual reasons. They may claim that:

  • You were not injured.
  • That your injury did not occur at work.
  • That you are not an employee or that you are an independent contractor.
  • The injury is a preexisting condition.
  • That you are ineligible for other reasons.

If the claims administrator approves your case, you may believe that you are entitled to additional compensation. If your claim is denied, you have a limited time to appeal, so it is important to immediately seek the assistance of qualified workers’ compensation lawyers.

What if I disagree with my benefits award?

Injured workers have rights in California, including the right to dispute the benefit amount awarded to you. You may be evaluated by a qualified medical evaluator (QME) who must meet certain licensing and educational requirements. Current law requires your attorney and the claims administrator to designate an agreed medical evaluator (AME), if an agreement is possible. This person conducts an independent medical review in which the AME or QME reviews all the available evidence and makes a recommendation to the judge.

How do I object to a claim denial?

To appeal your claim, your case must be heard at one of the Division of Workers’ Compensation offices throughout California. We file an application for adjudication of claim to have your case decided by a judge without a jury. Once you request a hearing, your case is referred to mediation. At a mandatory settlement conference, a judge attempts to effect a settlement between you and the claims administrator. If mediation fails, your case is set for trial.

At the trial, your case is heard by a different judge. By this time, your attorney has gathered as much evidence as possible to support your claim and is ready to refute the claims administrator’s arguments. The judge issues a written ruling, usually within 30 to 90 days. You may make one more appeal, this time to the state workers’ compensation board, by filing a petition for reconsideration. At this point, the entire process basically begins again.

Contact a Central Valley workers’ compensation attorney who understands your legal needs

At Perez, Williams, Medina & Rodriguez, LLP, our experienced attorneys take the time to listen to you and understand the facts of your case. We fully investigate the facts and create an effective strategy for proving your case to a judge or mediator. Contact our Fresno personal injury and workers’ compensation law firm at 559-445-0123 to schedule a free consultation to discuss your matter. Se habla español.

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