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What Happens if the Insurance Company Objects

Orange County Law Firm Fights Back when an Insurance Company Objects to Your Workers’ Comp Claim

Fighting for your right to receive benefits

By their very nature, workers’ compensation cases can make an injured worker appear to be the adversary of the employer and the applicable insurance company. Matters get even more heated if the employer or insurer objects to a claim for benefits or refuses to pay them. Thus, it is usually necessary for an injured employee to use a lawyer who is experienced with regard to workers’ comp claims in order to obtain the compensation due for the damages suffered. Tous Law Group, LLC works solely for the benefit of injured workers and we handle workers’ compensation disputes on a daily basis. We fight the insurance company for you and strive to obtain the full and fair compensation that you deserve.

Why would an insurer object to workers’ comp claims?

Invariably, it seems that insurance companies look for loopholes and reasons to deny claims in order to save money. Unfortunately, this is true in workers’ comp cases too. A common reason for a denial is that certain workers, such as independent contractors, are not eligible to receive benefits. An insurer may try to argue that you are an independent contractor and not an employee, and do not qualify for workers’ compensation coverage.

Typically, an injured worker must be examined by a doctor selected by the employer. Another common argument for denying workers’ compensation benefits is that the physician assigned by your employer has reported that you are not injured. Don’t let your legitimate claim for benefits be denied or delayed unfairly. Get us involved as early as possible to ensure that your claim receives the attention you deserve.

What happens when an insurer objects to a claim?

If your claim or any request for benefits is denied, the insurer should notify you in writing and set forth the reasons for the denied benefits. When you receive notice that your claim has been denied or the insurer is refusing to pay your claim, you need to take swift action to contact an attorney who can appeal the denial and aggressively fight to get you the benefits you are entitled to receive.

In California, the process for appealing a denied workers’ compensation claim is as follows:

  • If the insurer’s denial was based on one physician’s report, we can assist you with obtaining second and third opinions. If the insurance company still denies your claim after considering the diagnoses of three doctors, we can appeal the denial.
  • Your appeal begins with a hearing before a workers’ compensation administrative law judge (WCJ). The WCJ issues an award in your favor or confirms the denial of benefits.
  • If the denial is confirmed, we can file a Petition for Reconsideration.
  • The Workers’ Compensation Appeals Board reviews petitions for reconsideration to determine whether the WCJ decision should stand.

We understand that California’s appeals process is complex and confusing. Let us guide you through each step of the process to help ensure that the correct decision is obtained.

Obtain trustworthy advice from proficient workers’ comp attorneys in Orange County, CA

At Tous Law Group, LLC, we can assist with the denial of workers’ compensation benefits during any stage of the process. We are based out of Costa Mesa, CA, but for your convenience, we have offices in Los Angeles, San Francisco and Corona. Call us at 714-602-4473 or contact us online. All workers’ compensation cases are taken on a contingency basis, so if we do not obtain benefits for you, you do not pay attorney fees!