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Reasons your workers’ compensation claim might face denial

On Behalf of | Jul 24, 2023 | Blog, Workers' Compensation |

Workers’ compensation is an important protection for employees who suffer from work-related injuries or illnesses. If you are an employee in California, you might expect to secure these benefits automatically after a workplace incident. However, examiners can deny your claim in certain instances.

Understanding the reasons for these denials will help you prevent future disappointments and claim rejections.

The injury is not work-related

Workers’ compensation claims often face denial if the injury or illness does not relate to work. Your claim may face denial if you fail to show that your injury occurred at your workplace or during work-related duties.

Delay in reporting

California law mandates reporting work-related injuries to your employer within 30 days, and you must file your workers’ compensation claim within a year. If you do not adhere to this requirement, your claim may face denial. Always report any incident as soon as possible.

Inaccurate or incomplete documentation

The claim process relies heavily on accurate and complete information about the incident and your injury. If your documentation is incomplete, incorrect or inconsistent, the examiners might deny your claim.

Medical examination results

In California, the workers’ compensation board might ask you to undergo a medical examination by a designated doctor. If the exam results do not confirm the severity of your injury or illness, the examiners might deny your claim.

Lack of witnesses

Regrettably, if you were alone at the time of your injury and nobody else saw the incident, your claim might face more scrutiny and could result in denial. Although a lack of witnesses is not a valid reason for denial, incidents without witnesses often receive more scrutiny.

Understanding the reasons for workers’ compensation claim denials will guide you through the process more effectively. Always adhere to the required protocol, document everything meticulously and seek medical attention promptly to enhance your chances of a successful claim. Every detail matters when it comes to securing your deserved workers’ compensation benefits.