When you are injured on the job in California, you will probably be eligible to receive workers’ compensation benefits. But what if your workers’ comp claim is turned down? If that happens, an experienced Marin workers’ compensation attorney can help.

In California, workers’ compensation is an insurance program established and regulated by the state. Employers purchase workers’ compensation insurance for employees. When an employee is injured at work, that employee can file a claim and receive benefits as a result of the injury.

Determining who is qualified to receive benefit payments can be more complicated than you may think. A lot of people who work for a living in this state may not know whether they are eligible for workers’ comp benefits – or, if they are, they may not know how to apply for the benefits.

EVEN IF YOU UNDERSTAND WORKERS’ COMPENSATION, WHAT CAN HAPPEN?

But even when you are eligible for workers’ compensation payments – and you know what steps to take – workers’ compensation insurance companies frequently deny legitimate claims, and honest workers have to hire an attorney to obtain the benefits that they are entitled to by law.

Why are rightful claims sometimes denied, and what reasons are usually given?

If you’ll continue reading, these questions are about to be answered in this brief discussion of workers’ compensation benefits and your rights as an employee in the state of California.

WHAT ARE THE TOP REASONS FOR WORKERS’ COMP CLAIM DENIALS?

These are some of the leading purported reasons why a workers’ compensation insurance company might deny your claim for workers’ benefits:

  1. You did not immediately report the injury.
  2. Your accident report doesn’t match your medical records.
  3. Your medical exam showed illegal drugs in your system at the time of the accident.
  4. You have a pre-existing medical condition that’s related to your injury.
  5. You filed for workers’ comp after your employer fired you or you were laid off.

IF YOU DON’T REPORT A WORK INJURY AT ONCE, WHAT CAN HAPPEN?

If you fail to report a workplace accident immediately, the workers’ compensation insurance company will automatically presume that you were not really injured or that you weren’t injured seriously.

California law gives you thirty days to report a job-related injury to your employer. If you fail to meet that deadline, you will not receive workers’ compensation benefits. But you shouldn’t wait thirty days. The smart move is to report an accident and injury to your employer immediately.

If you are injured on the job, if it’s an injury that might keep you from working for a few days or weeks – or longer – report the incident at once and complete any necessary paperwork. Promptly reporting an injury keeps you compliant with the law and works in your favor if a dispute arises.

IF THE MEDICAL REPORT CONFLICTS WITH YOUR ACCIDENT REPORT …

If your written and spoken statements about a workplace accident and injury are inconsistent, or if you say that you were injured in a certain way and the doctor says that it happened in another way – or that you’re not seriously injured at all – your benefits claim will be jeopardized.

You really do have to tell the truth. Keep it simple and report precisely what happened, without emotion or exaggeration, when you talk to your supervisors, your HR department, and the healthcare providers. Tell the same, simple, consistent story.

Beyond those requirements, you probably should not speak in any detail about your case with anyone other than your workers’ compensation attorney.

IF THE MEDICAL EXAM SHOWS YOU WERE HIGH ON DRUGS OR ALCOHOL …

If an injured employee seeks immediate medical treatment – as you should – but the tests indicate that at the time of the accident you were intoxicated by drugs and/or alcohol, you probably will not receive any workers’ compensation benefits.

Additionally, if you were injured as a consequence of horseplay or as the result of a “practical joke” that you initiated, you almost certainly will not qualify to receive workers’ compensation payments.

WHAT IF YOU HAVE A PRE-EXISTING MEDICAL CONDITION?

If you had a pre-existing injury or illness that is unrelated to your current employment – but related in some way to your workplace injury – in most cases, a workers’ comp insurance company will fight aggressively to have your claim denied.

These cases can be complicated. If your claim for benefits is denied because of a pre-existing medical condition, an experienced Marin workers’ compensation attorney can arrange for you to have a second, independent medical exam.

Do not simply roll over and accept the rejection of your claim for benefits. A good workers’ comp lawyer can appeal the decision to reject your claim and will fight tenaciously on your behalf for the benefits that you are entitled to by law.

WHAT IF YOU’RE INJURED AT WORK – AND THEN FIRED OR LAID OFF?

When injured employees do not immediately submit a claim for workers’ comp benefits, they are sometimes terminated or laid off in the interim. Insurance companies view with suspicion workers’ comp claims that are submitted following a termination or a lay-off.

Insurance companies generally presume that post-termination and post-layoff workers’ comp claims are bogus claims motivated by anger or revenge against the employer. This is yet another reason why you must report your injury and file your claim as quickly as you can afterwards.

If you are not examined by a healthcare professional within 24 hours of a job-related injury, you may not be able to prove that the injury was a specific consequence of a specific workplace accident, and the insurance company will presume that you were not really seriously injured.

HOW DO WORKERS’ COMPENSATION ATTORNEYS HELP THEIR CLIENTS?

Workers’ compensation lawyers deal routinely with complex cases. If you are entitled to workers’ comp benefits, your attorney will know how to prove it.

When you’re injured, when you can’t work, and the bills are piling up, put your workers’ compensation claim in the hands of an experienced attorney who will provide the help you need to win the benefits you deserve.

In fact, if you are injured on the job anywhere in California, the wise step to take is to contact a workers’ compensation attorney as soon as possible after a workplace injury. Your attorney can help you file your claim and ensure that no mistakes or misunderstandings delay your benefits.

Workers in California have far more legal protection than the workers in most other states, but sometimes a working person needs a lawyer’s help to win justice. If you have been injured at work, get legal help now. Having the help of a good workers’ comp lawyer is your right.