Every California worker should know their rights under California workers’ compensation laws to ensure that they can get the benefits that they deserve. While your employer does have a right to dispute your claim for benefits under certain circumstances – if it unreasonably refuses to pay your workers’ compensation benefits, your employer is subject to fees and penalties under California law.


California Workers’ Compensation Lawyers Who Fight Denied Claims

Finding out that your employer denied your workers’ compensation claim is undeniably frustrating. When you face a setback like this, you need a lawyer who is ready to jump right in and start fighting back to try to get your claim for benefits moving in a more favorable direction.

Managing Attorney Matthew A. Schondel of Kneisler & Schondel has decades of experience successfully helping injured workers overcome difficult obstacles to recover the workers’ compensation benefits that they deserve. The legal team at Kneisler and Schondel takes pride in their strong work ethic and client-centered approach to helping people who have suffered work injuries obtain a variety of different benefits available under California’s workers’ compensation laws.

At Kneisler & Shondel, we are not afraid to take on challenging cases. Whether your case has been denied from the outset or you are dealing with a new dispute over a recommended medical procedure – we may be able to help. Contact us today to schedule a free consultation.


Steps to Take After a Work Injury to Protect Your Workers’ Comp Rights

There are a few things that an injured worker should do after suffering a work injury to help ensure that they have a compensable claim and are able to receive workers’ compensation benefits. Following the suggestions and rules expanded upon below will put an injured worker in a better position for success. 


Seek Necessary Medical Treatment

If you are injured at work, seek immediate medical treatment (if warranted) for your injury. You can have a co-worker or supervisor call an ambulance if needed. Some injuries may be mild and may not need urgent medical care, but seeking treatment as soon as possible after the work injury occurs is still important. What may initially seem like a minor muscle strain could end up being a more debilitating injury – it is always a good idea to see a doctor to have it checked out.


Report Your Injury to Your Employer

After obtaining medical care, it is imperative that you report your injury to your employer as soon as possible. You must report the injury to your supervisor, boss, or the owner of the company. If you only report it to a co-worker or someone else on the same level as you, it may not be considered proper notice to your employer. This step is critically important, because you may lose your right to receive any workers’ compensation benefits at all if you do not properly notify your employer of your injury.


Fill Out a Claim Form and Return it to Your Employer

Once you have given your employer proper notice, they should give you a Workers’ Compensation Claim Form (DWC – 1) to complete. You can use this form to request workers’ compensation benefits for your injury. At this point, you may want to contact a workers’ compensation attorney to represent you in your claim for compensation. Involving an attorney early on in the process is a good way to ensure that things progress promptly.

Before completing the form, read all of the instructions carefully, and then fill out the entire “Employee” section. After you have finished, you’ll then return the form to your employer. If you hire a California workers’ compensation lawyer, they will often want to review the Claim Form before you give it back to your employer.


What to Do When Your Employer Refuses to Pay Your Workers’ Compensation Benefits

While it is against the law for anyone to commit fraud (which is a felony) to obtain workers’ compensation benefits or payments – it is also against the law for anyone to commit fraud to deny an injured worker their benefits or payments. This law applies to everyone in the workers’ compensation system, including employers, injured workers, attorneys, doctors, and claims administrators.

However, an employer can decide to deny a workers’ compensation claim for several reasons. One common reason to deny a claim is because there appears to be a lack of medical evidence to substantiate the claim. Another reason a claim may be denied is because an employer’s internal investigation uncovered evidence that led them to believe that the injury is not work-related.


Challenging a Workers’ Compensation Claim Denial

Generally, if your workers’ compensation claim is denied, you will receive a letter from the claims administrator confirming the denial of the claim and explaining the basis for the denial. If you receive a letter denying your workers’ compensation claim, you do not have to accept it – you do have a right to challenge the decision.

If you find out that your workers’ compensation claim has been denied, the first thing you should do is to contact a California workers’ compensation attorney with experience litigating denied or disputed claims. An experienced attorney in this area can help you fight back against the dispute and work to potentially recover the benefits to which you are entitled.

It is crucial to move quickly when challenging the denial of a workers’ compensation claim because filing deadlines must be met in order to preserve your challenge of this decision. While it is highly advisable to proceed with attorney representation at this stage in the process, you can also move forward with a challenge to the denial of your claim on your own. To do so, you should contact the Information and Assistance Unit for guidance. 

Another resource to use when determining the proper procedures to follow when challenging the denial of a workers’ compensation claim is the State of California Division of Workers’ Compensation website. The forms necessary to request and proceed with a workers’ compensation hearing for a denial of benefits can be found here.


Workers’ Compensation Claim Hearings

Contested workers’ compensation claim denial cases are presented before a workers’ compensation administrative law judge. However, before you can have your case heard before a judge and potentially get the decision changed to one in your favor, you must file a form called an Application for Adjudication of Claim with the DWC office in the county in which you live or in which you were injured. The application must be served on all of the other parties, including the claims administrator. 


Next Steps Before Your Workers’ Compensation Claim Hearing

When you are ready for your case to proceed to a hearing before the administrative law judge, you will need to file a form called a Declaration of Readiness to Proceed. With this form, you will formally request a hearing on the matter of whether you should be entitled to workers’ compensation benefits – in other words, whether your claim was improperly denied.

However, before the actual court hearing on the matter moves forward, the judge will schedule your case for a Mandatory Settlement Conference hearing. During this hearing, you and the workers’ compensation claims administrator for your employer (or their attorney) will appear before the judge assigned to preside over the conference hearing.

During the conference hearing, the judge will discuss the case with all parties present and try to help facilitate a settlement. If you are able to agree on a settlement, then your claim will be resolved in accordance with the settlement terms. Alternatively, if the parties are unable to reach a settlement at the Mandatory Settlement Conference hearing, the case will be set for trial before the original administrative judge to which the case has been assigned.


How to Prepare for Your Workers’ Compensation Claim Hearing

Once your trial date has been set, you (and your attorney, if you have hired one) will begin preparing your case for trial. This process entails compiling all of the evidence in your case, which will typically include medical records, bills, and reports. 

If you have witnesses who plan to testify on your behalf, you should also confirm their availability for the trial date. If you have an attorney, they will usually want to go over the main points of your testimony with you beforehand to help eliminate nerves and refresh your memory.

After your trial has concluded, the judge will issue a written decision, which will be mailed to you. Generally, you will receive the written decision ruling on your case between 30 and 90 days after the trial has occurred. Remember that whether you win or lose – either party has the right to appeal the judge’s decision by filing a Petition for Reconsideration.


Getting Paid Workers Compensation Benefits After Your Employer Refuses

If your employer denies or disputes your claim for workers’ compensation benefits, there is no need to give up. An experienced California workers’ compensation attorney may be able to reverse that decision – or can help you present your case before a workers’ compensation administrative law judge who may rule in your favor. Contact the Law Office of Kneisler & Schondel today to learn more about how we may be able to help you.