San Francisco Workers: What to Do If Your Claim Is Denied

By Steve Franco

For many San Francisco workers, a denied workers’ compensation claim can feel like a devastating setback. Suffering an injury at work is stressful enough, and receiving a denial adds to the frustration. However, a San Francisco workers’ compensation denied claim does not mean you are out of options. Many workers successfully appeal denials and obtain the benefits they deserve.

If you are a worker in San Francisco facing a denied workers’ comp claim, here’s what you need to know about why claims get denied, how to appeal, and how an experienced workers’ compensation lawyer can help.

Common Reasons Workers’ Compensation Claims Are Denied

Missed Deadlines – Failing to report your injury within 30 days or not filing a claim within one year can result in denial.
Lack of Medical Evidence – If there isn’t enough documentation linking your injury to your job, the insurance company may reject your claim.
Employer Disputes the Claim – Your employer might argue that your injury did not happen at work or that it resulted from pre-existing conditions.
Failure to Seek Medical Treatment – Delays in seeking medical attention after an accident can raise doubts about the seriousness or work-relatedness of your injury.
Injury Not Covered – Certain injuries, such as stress-related or cumulative trauma claims, may require more proof to establish their work-related nature.

Steps to Take After a Denied Workers’ Compensation Claim

1. Review the Denial Letter

Your denial letter will explain why your claim was rejected. Understanding this reason is crucial for preparing an appeal.

2. Speak with Your Employer or Insurance Adjuster

Sometimes, denials happen due to missing paperwork or misunderstandings. Contact your employer or the insurance company to clarify any issues.

3. File an Appeal with the Workers’ Compensation Appeals Board (WCAB)

If your claim remains denied, you can challenge the decision by filing an Application for Adjudication of Claim with the San Francisco Workers’ Compensation Appeals Board (WCAB).

4. Request a Qualified Medical Evaluation (QME)

If your denial is based on medical evidence, you can request a Qualified Medical Evaluator (QME) to review your case.

5. Gather Additional Evidence

Strengthening your case with medical records, witness statements, and job-related documentation can help overturn the denial.

6. Attend a Workers’ Compensation Hearing

If a settlement isn’t reached, your case may proceed to a trial before a workers’ compensation judge.

How a Workers’ Compensation Lawyer Can Help

Having a lawyer can significantly increase your chances of success. A skilled San Francisco workers’ compensation lawyer can:

Analyze your case and determine the best appeal strategy.
Gather medical evidence and connect you with expert doctors.
File necessary paperwork and ensure you meet all legal deadlines.
Negotiate with insurance companies to maximize your benefits.
Represent you in hearings and trials before the WCAB.

Get Help with Your Denied Workers’ Compensation Claim

A claim denial doesn’t have to be the end of your case. At Franco Muñoz Law Firm, we specialize in helping injured workers in San Francisco fight for the benefits they deserve.

Call us today at (510) 257-4141 for a free consultation or visit our website at www.francomunoz.com.

Don’t let a denied claim stop you from getting the compensation you need. Take action now and protect your future!

External Links for Additional Information

California Division of Workers’ Compensation – Learn more about California’s workers’ compensation process.
Workers’ Compensation Appeals Board (WCAB) – File an appeal and check case status.
State of California Qualified Medical Evaluators (QME) – Find a medical evaluator for your claim.

About the Author

Steve Franco – Workers’ Compensation Attorney

Steve Franco is a highly experienced workers’ compensation attorney in San Francisco. He has successfully fought for injured workers’ rights, securing millions in benefits. If you need expert legal assistance, contact Steve today.

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