Denied Cases

Denied Claim Attorney in San Diego

Each year, many workers’ compensation claims are denied. When this happens, injured workers go without financial recovery and sometimes don’t receive the medical care they need.

Worker’s compensation benefits are denied for a variety of reasons. Following are some common reasons your workers’ compensation claim may have been denied:

  • Your injury was caused by a preexisting injury or condition
  • Your injury did not occur while performing your job
  • A health provider concluded you were not disabled as a result of your work injury
  • Dispute as to when or where the injury occurred
  • Dispute about whether you sustained injuries at all

If your claim is denied, you will receive a letter indicating why your claim did not qualify for workers’ compensation benefits.  You can challenge the decision on your own, requesting that the insurance company reconsider its decision. A different result is unlikely, unless you are able to provide more information such as supplementary medical evidence and IMR. Getting a reputable San Diego attorney or a specialized stress attorney in San Diego can help you navigate the complicated workers compensation system.

If your workers’ compensation claim has been denied, your best prospect of successfully appealing the decision is to consult with a participating workers comp attorney at the Workers’ Compensation Attorney Group. A delayed cases lawyer in San Diego with years of experience or a competent San Diego RSD attorney is familiar with the complex workers’ compensation system and the complicated appeal process. They will aggressively represent you, making sure you receive the medical treatment and the financial benefits that are rightfully yours. Don’t delay! The sooner you contact us, the sooner we can get to work on your case!

What Happens When an Insurance Company Objects to Your Medical Treatment?

Approximately 12 years ago, any California worker could go to whatever doctor they wanted to in order to receive treatment and still qualify for workers compensation. These days, you need to see a physician associated with the employer’s medical provider network (MPN) instead. This rule is in place to ensure that their insurance company will pay for your treatment.

You Can Still See Your Choice of Doctor

Of course, no one will ever stop you from making an appointment with your family physician and getting their opinion about your health and well-being. If you have health insurance through your employer or family, that will cover the expense according to the rules of your policy. However, if you want to make a workers comp claim, you must see a physician in the medical provider network approved by your company’s insurer.

In the absence of an MPN, this rule does not apply. However, the insurance company still has the legal right to insist that you see a doctor of their choosing. This rule lasts from the time you report the injury until 30 days later. They should give you some options to choose from.

Your employer’s insurance company does not want to pay for expensive medical care. However, you have rights that a qualified attorney can explain to you. This makes it exceptionally important contact one as soon as possible after the incident occurs.

What if the insurance company’s chosen physician claims you do not have a serious injury that qualifies for workers comp benefits? Again, you need trusted legal counsel on your side to navigate this tricky process. In fact, a lawyer can help fight for your right to sufficient and appropriate medical treatment. This can occur within those first 30 days and four months or even years to come.

Do Not Handle Disputes Alone

Although you would like to believe that the insurance company’s doctor and your family physician would agree on your diagnosis and treatment plan, this may not happen. Unfortunately, the medical community is sometimes fueled by profits, and the insurance company has a lot of influence on what their physicians allow for treatment. Your lawyer can handle these disputes and make sure that the compensation you ultimately receive covers the treatment you needed and not just watch the insurance company wanted to pay for.

In particular stressful times after an accident or other injury at work, you need someone who will stand up for your legal rights and protect your access to proper medical care. The attorneys here work exceptionally hard to serve every client in a custom manner that approaches their case individually.

Your attorney can help identify the best doctor in the MPN, handle medical documentation between different doctors to match up diagnoses and treatment plans, and do everything possible to get the right amount of money to cover what you need to heal.

Denied Claim Lawyer in San Diego

Call the Workers’ Compensation Attorney Group at 619-798-6487 to schedule a no-cost, no-obligation consultation about your denied workers’ comp case.