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Denied Workers' Compensation Benefits & Appeals Attorney in Oakland, California

Are you dealing with an injury sustained at work and have your workers' compensation benefits been denied? You're not alone. According to the Bureau of Labor Statistics, millions of Americans suffer workplace injuries each year—and far too many times, employers or their insurance companies are reluctant to pay out deserved benefits or they find seemingly any excuse to deny a legitimate claim. Fortunately, there is hope for those seeking justice via the appeals process.  

At The Law Office of Robert E. Wood, we understand that navigating workers' compensation claims can be challenging, especially when your claim gets denied. You don't need to face this on your own. Contact our office in Oakland, California, to schedule a free consultation with an experienced workers' compensation attorney. We're proud to serve workers throughout the San Francisco Bay Area.  

Reasons a Workers’ Compensation Claim May Be Denied

There are several reasons why your claim may be denied. It could be due to:  

  • A lack of notice if you didn't report the injury or illness to your employer within the specified timeframe (in California, you typically have 30 days to provide notice). 

  • Your employer can prove that your injury or illness existed prior to your employment. 

  • Disputes over whether your injury or illness is work-related can also lead to denial.  

  • Missing important deadlines or not filing the claim within the statute of limitations (in California, the statute of limitations is generally one year). 

  • Failing to provide enough evidence. 

We're here to help you understand these potential reasons for denial and guide you on how to address them effectively.

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Notice of Controversion

A Notice of Controversion is a formal notice filed by an employer or insurance company to contest a workers' compensation claim. It states the reasons for denying the claim and must be filed within a specific timeframe after receiving notice of the claim. Our attorney can help you understand the implications of this document and how it affects your workers' compensation claim. 

What to Do if Your Workers' Compensation Claim Is Denied

If your workers' compensation claim is denied, don't worry. We're here to guide you through the next steps.  

First, we'll carefully review the denial letter to understand the reasons for the denial. We'll provide you with legal advice and evaluate your case thoroughly. If we believe the denial is unjust, we'll help you file an appeal, which involves submitting the necessary paperwork and supporting evidence to the appropriate workers' compensation appeals board—find more on the specifics of that process below. 

We'll also help you prepare for the appeals process, gather all relevant medical records, witness statements, and any other evidence that supports your claim. Be prepared to attend hearings and present your case before the workers' compensation appeals board. We'll be there to guide you through the process and advocate for your rights every step of the way. 

Appealing a Decision

When appealing a workers' compensation decision, several things need to be considered. First, you need to know your deadline for filing your appeal. In California, the deadline is typically within 20 days of receiving the Notice of Controversion or denial letter. 

Application for Adjudication of Claim

Next, you'll need to file an Application for Adjudication of Claim form. This is a formal request to have your case heard by the workers' compensation appeals board. The application must be filed at the Division of Workers' Compensation (DWC) office in the county where you live or where you were injured. 

This document essentially opens up your case for review by a Workers' Compensation Administrative Law Judge. It includes relevant details about your injury, employment, and the benefits you believe you are entitled to. Once filed, you'll be assigned a case number, which will be used in all future correspondence related to your case. If you believe your claim has been unfairly denied, we can help you file this application to initiate an appeal.  

Declaration of Readiness to Proceed

Once the Application for Adjudication of Claim has been filed and your case is open, we'll help you to file a Declaration of Readiness to Proceed. This document signifies that you're ready to move forward with the appeals process. It's a formal request for a hearing before a judge, and it's an essential step towards getting your case heard. 

By filing this document, you're essentially stating that you've gathered all necessary evidence, completed all required paperwork, and are ready to present your case in court. The DWC office will then schedule a hearing called a Mandatory Settlement Conference (MSC). At this conference, we'll represent you and negotiate with the claims administrator or their attorney in an attempt to reach a settlement. If a settlement can't be reached, we will zealously advocate for you in trial. 

Accepting a Settlement

If you decide to accept a settlement for your workers' compensation claim, you might enter into a Compromise and Release Agreement. This agreement is a legally binding contract between you and the employer or insurance company. We'll help you carefully evaluate the proposed settlement amount to ensure it adequately compensates you for your injuries, medical expenses, lost wages, and future needs. 

By accepting a settlement, you typically waive your right to pursue any future claims related to the injury or illness. Therefore, it's crucial to have us review the settlement agreement to ensure your rights are protected and the terms are fair. Accepting a settlement can provide closure and financial stability, but it's essential to make an informed decision with the help of professional legal advice. 

Denied Claims & Appeals Attorney in Oakland, California

Having us by your side can increase your chances of a successful appeal. We'll guide you through the appeals process, help you file all necessary documents, and represent your interests during hearings. At The Law Office of Robert E. Wood, we're dedicated to helping you navigate through these difficult times. With our extensive knowledge and practical approach, we’re ready to be your advocate. Contact us today for professional legal services in workers' compensation.