$ 45 Million

Permanent Disability

$ 55 Million

Temporary Disability

$ 5 Million

Death Caused By Work

$ 100 Million

Denied Workers' Comp Recovery

What Should You Do Now?

You may find your world crashing down if your workers' comp claim was denied in California. Don't panic just yet! We're here to provide relief and recover your fair due.

First, if your workers' comp claim was denied, you must know you are not alone. Nearly 15% of injury claims are denied annually for reasons within or beyond the applicant’s control. That’s not all; nearly 33% of repetitive trauma claims arising out of one's workplace, and 60% of injury aggravation claims from previously accepted workers' comp cases are denied.

However, you must also know that nearly two-thirds of denied workers’ comp claims are successfully overturned within a year. But why should you settle for less when you can recover the complete payout with The Law Office of Joseph Pluta? We have the experience, the expertise, and the skill required, so why not join hands with us?

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Can Workers Comp Be Denied? Yes, Learn Why

Once you know the reason for your workers' comp denial, you'll know what to work on as a remedy for your situation

  • Disputed Injury: You can only claim workers’ compensation if your injury was directly connected to your work. However, your compensation may be denied if your employer can establish that your injury occurred while you were on break or not working. Similarly, your employer may establish that your injury occurred due to a pre-existing condition and not necessarily because of conditions at work. If you have a pre-existing condition, you may qualify for benefits under the Subsequent Injuries Benefit Trust Fund (SIBTF). The Law Office of Joseph Pluta can help with SIBTF claims, too.

  • Delayed Application: If you do not file your workers’ compensation application within the stipulated deadline, your employer will be within their legal rights to reject your workers’ comp claim. You must know that the deadline for reporting your injury to your employer is 30 days and that filing a workers’ comp case is 12 months from the injury's reporting date. However, the good news is that the Law Office of Joseph Pluta may still be able to help even if you don't report your injury within 30 days.

  • Illness/Effects on Body Not Covered: California does not recognize workers’ compensation for pain and suffering or punitive damages. Additionally, workers’ comp is not awarded for self-inflicted injuries, where the intoxication led to the injury itself, or those that occur off work hours and after you’ve been fired/laid off.

  • Failure to Seek Medical Attention: If you do not consult a doctor for your work-related injury, the insurance company can gain solid ground to argue that your injury was not severe enough to warrant medical attention.

  • Incomplete/Inaccurate Documentation: Submitting incomplete medical records and requested documentation or showing inconsistency with your statements can result in claim denial.

  • Injury Resulting from A Crime/Fight: Your workers’ compensation claim stands at risk of denial if your injury at work resulted from an intentional fight where you were the initial physical aggressor, or when you were involved in a crime.

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What Should You Do Now?

As the first step, relax now that you’ve found the Law Office of Joseph Pluta for legal assistance. As the next step, follow the instructions outlined below:

The good news is, if your claim is denied, that's not the end of the story. Injured workers in California can pursue a formal claim with the Workers' Compensation Appeals Board

Application for Adjudication of Claim

File an Application for Adjudication of Claim with the California Workers' Compensation Appeals Board (WCAB) within one year of the injury or the date medical treatment ended. Ensure you file the claim personally at the Department of Workers' Compensation in the county where you live or where the injury occurred. Our denied workers' compensation claim attorney can help you fill in the correct details to overturn your workers' comp denial.

After successfully submitting your application, your employer must respond within 10 days. When claims are denied, the next step is an evaluation with a Qualified Medical Examiner (QME) to gather medical evidence in support of your claim.

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Declaration of Readiness to Proceed

California law mandates all parties to attempt to settle the case by fscheduling a "meet and confer" with the opposing party prior to filing a declaration of readiness to proceed to a hearing in front of a Judge. The facts and circumstances specific to your case will determine which type of hearing is necessary.

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Mandatory Settlement Conference

Once your case is ready for settlement, the parties attempt to settle the case at the Mandatory Settlement Conference or set the matter for trial. The two types of settlements available at a Mandatory Settlement Conference are:

  • Stipulations with Request to Award: When this type of settlement is agreed upon, you may receive a weekly payout with medical cost coverage if necessary.
  • Compromise & Release: You will not receive any weekly payments under this system. Instead, you will receive a lump sum settlement that can cover your future medical requirements.

If the parties are unable to reach settlement at the Mandatory Settlement Conference, your case will be set for trial in the next available slot on the Court's docket.

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Contact Us Before All Else

You don't have to take the insurance company's word if your workers' compensation case is denied. Contact the experts at the Law Office of Joseph Pluta to ensure you're not leaving money on the table

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We're On Your Side

Our denied workers compensation claim attorneys have a long history of fighting for the underdog. We understand how to navigate this complicated system and avoid the obstacles in in your path.

  • Proactive Legal Support
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  • 6000+ Injured Workers Helped
  • We Win, or You Pay Nothing!
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Hear From Our Happy Clients

I can't express my gratitude to The Law Office of Joseph Pluta for their exceptional service in handling my denied workers' compensation claim. After my initial claim was rejected, I felt hopeless and overwhelmed by the complex legal process. However, Joseph Pluta and his team took the time to understand my situation and provided invaluable guidance every step of the way. They were knowledgeable about the intricacies of workers' comp law and genuinely cared about my well-being. Thanks to their expertise and persistence, my claim was overturned, and I received the compensation I deserved. I highly recommend their services to anyone facing a similar situation—trust me, you’re in great hands!

Greg Philip

I was devastated when I received the news that my workers' compensation claim was denied. I only knew what to do once I contacted The Law Office of Joseph Pluta. Joe and his team were incredibly supportive and reassuring from the first consultation. They took the time to explain my options and crafted a strong appeal on my behalf. Their dedication was evident in every communication, and they kept me informed throughout the process. With their expertise, my denied claim was overturned, allowing me to finally focus on my recovery without the burden of financial stress. I cannot recommend The Law Office of Joseph Pluta enough—if you need help with a workers' compensation claim, this is the firm to trust!

Robert Acosta

After my workers' compensation claim was denied, I felt lost and frustrated. That’s when I found The Law Office of Joseph Pluta, and I can honestly say it was a turning point for me. Joseph and his team were professional, knowledgeable, and incredibly compassionate. They listened to my story, understood my concerns, and took immediate action to help me overturn my denied claim. Their communication and support made all the difference; I felt I was their priority. Thanks to their hard work and expertise, my appeal was successful, and I received the compensation I was owed. I wholeheartedly recommend The Law Office of Joseph Pluta to anyone struggling with a workers' compensation issue. They, indeed are advocates for their clients!

Alina Stacy

Frequently Asked Questions

Find frequently asked questions answered by our denied workers' compensation claim attorney

Although it is not incumbent upon any insurance provider to reimburse medical expenses for injured employees, they still have to cater for those expenses when workplace injury compensation has been rejected. Then, you will not be forced to incur treatment costs by yourself.

You also have a few other options available:

  • Group/personal health insurance :Either group or individual health insurance providers can afford to settle the outstanding medical bills even if the workers' compensation claim is still in progress. So does your spouse's group health insurance. But for that, you should realize that payment entitlement depends upon submitting a dispute notice. In most cases, companies push the clients to sign the reimbursement agreement, which permits the insurer to deduct its reimbursement from the settlement amounts.
  • Medicaid and Medicare :If you do not hold either group or individual health coverage, then Medicaid would likely offset your medical expenses. However, access is only granted to workers with low earning potential and ownership of personal assets. Medicaid is undoubtedly an improvement over self-pay, but there are upsides and downsides. The program, for example, is infamous for its reimbursement levels, which means you will have to make do with inferior-quality treatment. Many healthcare providers also refuse to accept Medicaid, hence a concern about having to forgo additional time searching for a healthcare provider.

If your employer rejects your worker compensation request, a communication will be sent to officially inform you of their decision. You may contest or appeal this refusal with the relevant authorities, the California Division of Workers' Compensation or DWC.

The initial stage of refuting a California workers' compensation claim denial involves the prompt submission of an Application for Adjudication of Claim (together with the necessary documentation) to the district office of the Division of Workers' Compensation situated nearest to you. The Application of Adjudication for Claim should be submitted within twelve months from the date of the injury.

To ensure that your Application for Adjudication of Claim is filed with the appropriate authority within one year of the occurrence of your injury, instead of simply attempting to post it to the DWC District office, the best course of action would be to file the Application together with supporting documents in person at the office of the DWC District, and for purposes of record, request for a filed copy of the documents. Additionally, you must provide proof of service that you sent the Adjudication of Claim to your employer and the employer's workers' compensation insurance company.

Suppose an employer opts out of the Workers' Compensation statutes and an employee sustains an injury. In that case, the employee may, in turn, file a lawsuit against the employer-and the employer is not allowed to rely on standard legal defenses like assumptions of risk, contributory negligence, or negligence of a co-worker. Failure to comply can adversely affect an employer's standing and make hiring and keeping personnel challenging.

An injury at work does not preclude the availability of a typical personal injury lawsuit because pain and suffering are included. We will explain this but also provide options and a recommended way forward.

When an individual is harmed in some form, the term "pain and suffering" is frequently used in court proceedings. It simply explains the physical pain one might have suffered due to an illness or injury. The anxiety about your condition itself and the hurt it has caused would also form part of one's pain and suffering. Other more psychological terms of suffering, such as stress, denial, or humiliation, are within the realm of pain and suffering. Pain and suffering and punitive damages are not usually available under workers' compensation laws.

The so-called 90-day waiting period under California workers' compensation norms dictates that within 90 days of your claim being lodged, the workers' compensation insurer must decide on the claim. This will be so unless the claim is accepted, denied, or extended further consideration if, within 90 days, it has not been accepted or further consideration has been extended. The carrier can agree to extend the term. The carrier must also send you the Notice of Delay explaining why the decision has been delayed and request any necessary documents to decide on your claim.

Suppose you have submitted a California workers' compensation claim that has been pending for more than ninety days, and no postponement was received, a denial was received, or no acceptance or payment was provided. In that case, it is a good idea to sue. An attorney will help you fight for your well-deserved compensation in such a case.

If you live in California, you are interested in the impressive scenarios that people might end up injured due to others or that injury claim settlements might be awarded. It is essential to appreciate that these figures are not cast in stone and can differ extensively depending on various factors, such as the specific character of the case and the extent to which you suffered.

In some states, there are limits on the amount of money that can be recovered as financial compensation. This is not the case for personal injury suits in California. The offenders need to pay you the amount that would be allowed by the court, irrespective of how high your claim may be. This does not mean that there is no limit. An upper limit mark is set in such cases to protect doctors and the whole medical professional body. In California, certain non-economic payments can be within the plaintiff's capacity from the injury; no matter how severe the injuries are, you will rarely receive more than $ 250,000 in non-economic damages. If your claim arises from medical negligence, quickly locate an excellent lawyer to determine your worth.

Call Today For Your Free Initial Consultation At (661) 395-1031

DISCLAIMER: This website contains general information and is only intended for educational purposes. Because laws are constantly changing, the information is not guaranteed to be correct and/or current. Nothing contained on this website is intended to be a substitute for legal advice and does not constitute legal advice. Reading this website does not create, and should not be construed to create, an attorney-client relationship between the Law Office of Joseph Pluta and the reader. Nothing within this website should be considered as providing legal advice or a legal opinion. Sending an E-Mail to this website, or interacting with this website in any other way, does not create an attorney-client relationship.