In most instances, California workers who suffer injuries or illnesses on the job are entitled to coverage of lost wages and medical expenses under state workers’ compensation laws. Many people take it for granted that benefits will begin soon after their work-related injuries, but they can then run into obstacles in the claim process.
Having the right legal help can increase your chances of success in your claim so you can begin receiving benefits as soon as possible. Reach out to a Pomona personal injury attorney for more information today.
What Does Workers’ Compensation Coverage Provide?
Workers’ compensation can be a life-saver for someone facing the aftermath of a job-related injury or illness. Such medical conditions can require costly treatment and can cause someone to be out of work for quite some time – or even the rest of their working lives. Benefits aim to provide support by covering:
- All medical expenses related to treating the workplace injury or illness
- A percentage of wage replacement for the time you missed from work
- Disability benefits if you cannot work in the future or can only work part-time
You can be eligible for such benefits even if you made a mistake that caused your injuries. Workers’ compensation is a no-fault system, so almost anyone injured in the course of employment should qualify for the above benefits. Unfortunately, workers’ compensation insurers can make the process more challenging and complicated than it needs to be, which means it can help to have a Pomona workers’ compensation lawyer handling your claim.
Insurance Companies Challenge Claims
When you have a claim with a workers’ compensation insurance company, you likely expect to receive benefits in short order. You might not realize that your claim will be carefully scrutinized by the insurance company to determine if your claim has any shortcomings that might enable them to deny it. Both insurance adjusters and investigators will be working to challenge your claim and eligibility for benefits.
For your initial claim to qualify, it must be fully accurate, complete, and include sufficient evidence to indicate that you are entitled to benefits. If you are filing your first workers’ compensation insurance claim, as most claimants are, it is natural that you might not have an in-depth knowledge of the process or know all the evidence that your claim must include for approval.
An experienced workers’ compensation attorney has this experience and knows how to present strong evidence from the start on your behalf. Further, your workers’ compensation attorney takes the stress of your claim out of your day-to-day life, so that you can focus on recovering and getting on with your life. You can dedicate yourself to your medical treatment and improvement while your attorney applies their knowledge of the law and the insurance process to your claim.
Common Insurance Company Tactics
One of the underlying goals of the insurance company is delaying or denying your initial claim is to avoid paying the full amount of benefits that you deserve. Insurance investigators can watch you for any indication that you are exaggerating your injuries. Often, delays happen when the insurer challenges certain medical treatments or time or work as being unnecessary.
If you are experiencing delays in your claim or other challenges, do not simply accept them as part of the process. This is the insurance company trying to minimize its liability to increase its profits. Instead, speak with an attorney who has experience working with workers’ compensation insurance companies.
We can identify the reason for a delay or another claim challenge and try to clear the matter up as soon as possible. Often, early intervention by an attorney can avoid a claim denial, so you do not have to wait through the appeals process to start receiving benefits.
Occupational and Medical Expert Opinions to Support Your Claim
One of the common excuses provided by workers’ compensation insurance companies for refusing to pay out on claims is insufficient evidence that you need benefits. The insurer might state you did not convince them that your injuries:
- Required all the treatment you received
- Should have kept you from working
- Continues to prevent you from returning to work in the future
If your workers’ compensation claim denies your application, it may be due to insufficient evidence, and the help of medical or occupational experts might be required. Experts can review your situation and report on the severity of your injuries, the standard recommended treatment or future treatment, and how your injury would normally impact the ability to work.
An experienced workers’ compensation attorney should have a network of medical and occupational experts who work with them on claims. We know how to identify the need for relevant expert evidence and how to present it in support of your claim. Our firm knows which experts are qualified and accurate and will help fill in any gaps or address insurance company challenges of your claim.
Appealing a Workers’ Compensation Denial
When your initial application is denied by the insurance company, you then have the option of appealing the decision. The appeals process can be complicated and extensive, and there are many steps to take, procedures to follow, and deadlines to meet.
If your claim was denied, your very first call should be to our workers’ compensation law firm. Any errors during your appeal can jeopardize your right to receive future benefits at all. Do not take this risk, and instead, seek the legal representation you need for your appeal as soon as possible.
Connect with a Pomona Workers’ Compensation Lawyer Now
For some people, the workers’ compensation claim process is anything but simple. There can be surprising obstacles to obtaining the benefits you deserve under the law, but the right legal assistance can help to minimize hiccups and get your benefits paid as soon as possible. Reach out to an experienced Pomona workers’ compensation lawyer to schedule a consultation regarding your situation. We can help from the very start of the claim process or at any stage along the way.
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