Workers’ compensation insurance companies are huge businesses. They make money by cashing premium checks, and they make even more money by investing the cash from those premiums. Like any other business, insurance companies want to keep as much of that money as possible, but they have claims that must be resolved one way or another. When a claim is made against an insured person or entity, a file is opened, and an adjuster is assigned. It’s the job of that claims adjuster to pay as little as possible or even nothing at all by denying the claim.
Reporting the Claim
After being notified of a work-related injury, the employer is required to provide the injured employee with an appropriate claim form within one day. Once the form is completed and returned to the employer, that employer must forward it to its workers’ compensation insurer.
As per the California Labor Code section 5402(b), if a workers’ compensation claim is going to be denied, the insurer must deny it within 90 days of the date of submission. If the insurer fails to deny it within the specified time, the injury is presumed compensable. If the employer’s insurer does deny the claim, it’s likely to be for one of the three following reasons:
- The injury didn’t occur during the course and scope of the worker’s employment.
- The injured worker wasn’t an employee of the person or entity that the claim was made against.
- The injured employee provided insufficient information and documentation as to the nature and extent of his or her injuries.
If your workers’ compensation claim arose in or around Sacramento, and it was denied by your employer’s insurer, you’ll want to contact us right away. You’re going to need our help in filing appropriate documents. You’ll also need help in preparing and arguing your appeal. The Workers’ Compensation Appeals Board can overturn a denial, but there are strict time limits to contest denials. If you fail to timely file a proper petition to overturn a denial, you can be permanently barred from ever trying to overturn that denial in the future.
Contact a Sacramento Workers’ Compensation Lawyer
If you’ve been injured in a work-related accident, give notice, get medical treatment and contact us right after that. Make sure that you get a copy of your notice. If you wait too long, your claim can be denied. Always remember that after a denial, legal options are still open, but you’re going to need experienced and aggressive legal representation right away.
Sacramento Workers’ Compensation Attorney, Alice A. Strömbom, focuses exclusively on Workers’ Compensation Law and the rights of injured workers. She is very familiar with the tactics insurance companies use to avoid providing the medical treatment and disability benefits injured workers deserve, and has a recognized track record in combating such issues.
Contact us today for a free, confidential consultation and case evaluation.