Receiving a workers comp denial letter does not mean that compensation cannot be provided. With the help of a workers comp attorney, you can still receive compensation if certain criteria is met under California law.
SoCal Workers Comp is a workers-only firm exclusively devoted to protecting California workers who have been hurt on the job. Our team is ready to take on any California employer, no matter how large, to ensure your rights are protected and you receive the compensation you are rightfully owed.
Receiving a notice from an insurance carrier doesn't always mean your case is over, but it does mean you need to act quickly. It is vital to distinguish between a full denial of liability and a simple delay in benefits, as each requires a different legal strategy. A workers comp attorney can help you decipher the complex language used by adjusters to ensure you aren't being unfairly deprived of medical treatment or lost wages.
When your workers comp denied claim status is unclear, look for specific language regarding "liability." Common types of notices include:
1. Full Denial of Liability: The carrier claims your injury did not arise out of employment (AOE) or occur in the course of employment (COE).
2. Delay Notices: The carrier states they need more time (up to 90 days) to investigate the claim before making a final decision.
3.Medical Benefit Denial: The carrier may accept the injury but deny specific treatments, often citing a lack of "medical necessity."
4. Temporary Disability Denial: The carrier admits you were hurt but claims you are capable of working, thus denying wage replacement.
A common tactic used in a workers compensation denial letter is the claim of "No Probative Evidence." This is a technical way for insurance carriers to justify denying workers compensation claim liability by asserting there is no medical or factual proof that your injury happened at work or is as serious as you report.
They may point to a delay in reporting the injury or a lack of witnesses to suggest the incident never occurred. However, SoCal Workers Comp specializes in uncovering the truth, gathering medical records, and securing the testimony needed to prove your case and hold your employer accountable.
Under Labor Code 5402(c), California law provides a specific protection for injured workers during the investigation phase of a claim. While the insurance company is deciding whether to accept or deny your case, they are required to authorize medical treatment up to a limit of $10,000.
If you have a workers comp denied claim that is currently delayed, you are still entitled to this care. A knowledgeable workers comp lawyer ensures that the carrier does not ignore this statutory obligation, allowing you to see a doctor and document your injuries immediately.
Insurance adjusters often send a stack of forms following a workplace injury, including broad medical release authorizations.
Be warned: these forms often grant carriers unrestricted access to your entire private health history, including information completely unrelated to your workplace injury.
Insurance companies use this to find pre-existing conditions they can use to blame for your current pain.
Before signing anything that compromises your privacy, consult with SoCal Workers Comp to ensure you are only releasing information relevant to your current claim.
At SoCal Workers Comp, we see numerous workplace shoulder injuries, including:
Workers across many industries suffer shoulder injuries on the job, especially those that require lifting, reaching, or repetitive motion:
Hurt on the job? We can fight for your benefits.
In California, you have workers’ comp rights to protect you. If your injury is work-related, you may be entitled to:
If you can’t work because of your injury, you could qualify for temporary total disability (TTD) benefits – generally two-thirds of your average weekly wage. If you experience lasting impairment, you may be eligible for permanent disability as well. An attorney can determine eligibility and obtain the benefits you are entitled to.
California law guarantees your right to medical treatment for job-related injuries, including:
If your employer’s insurance is delaying care or denying coverage, we can step in and enforce your rights.
If you receive a workers comp denial letter, the carrier will likely trigger the Qualified Medical Evaluator (QME) process. This involves a state-issued list of three doctors; you have a strict 10-day window to "strike" one doctor from this panel to prevent the insurance company from choosing a physician who favors their interests.
Missing this deadline can be catastrophic for your case, as the QME's report often dictates your future medical care and permanent disability rating.
You should report your work-related injury as soon as possible in California. Delaying the report often gives the insurance company an excuse to issue a denied workers compensation claim based on a "lack of probative evidence".
No. SoCal Workers Comp takes cases on a contingency basis, meaning you don't pay unless we secure compensation for you.
You still have rights. You may be able to seek benefits through the Uninsured Employers Benefits Trust Fund (UEBTF), and a workers comp lawyer can help you navigate this specific legal path.
Yes, through the Subsequent Injuries Benefits Trust Fund (SIBTF), you may qualify for lifetime weekly payments if a new work injury combines with a prior disability to create a total disability of 70% or more.
This is a standard tactic where the carrier claims there isn't enough medical proof to link your injury to your job. We counter this by utilizing our medical resources to provide the necessary expert proof.
If your claim is stalled or denied, we follow a proven path to secure the justice you deserve:
Our legal team will intervene immediately to ensure your medical treatment is authorized and your benefits are paid in full.
