Denied & Delayed Claims

A denied or delayed workers’ compensation claim does not mean your case is over. It often means the fight is just beginning. Insurers delay and deny claims for all kinds of reasons, some valid and many not, and a decision you accept without challenge can become permanent even when it was wrong.

Knowing your rights, and the deadlines that apply, is what stands between a bad decision and the benefits you are actually owed.

Delayed Claims and the 90-Day Rule

In California, an insurer generally has 90 days to accept or deny your claim after you file, and they must authorize up to $10,000 in medical treatment while they investigate. If they do not deny the claim within that window, it is presumed accepted. When a claim is delayed, the insurer is supposed to send you a letter explaining why and what information they still need. Too often, delays stretch on while bills pile up and you go without the income you were counting on.

Why Claims Get Denied

A denial is different but not final. Insurers deny claims for many reasons, some legitimate and many not. They may argue the injury was not work-related, that it existed before your job, that you missed a deadline, or simply that they need more evidence. A denial you do not challenge becomes permanent, even when it was wrong.

Common reasons claims are denied or delayed include:

  • The insurer disputes that the injury was work-related
  • Missed or disputed reporting deadlines
  • The insurer blames a pre-existing condition
  • Insufficient medical evidence, in the insurer’s view
  • Simple administrative delay while you wait for benefits

How to Fight Back

You have the right to challenge a denial through California’s workers’ compensation appeals process, and delayed payments can carry penalties the insurer owes you.

California workers’ compensation attorneys work on contingency, so there is nothing to pay upfront and a fee only if you recover. If your claim has been denied or your benefits are delayed, talk to an attorney before you accept the insurer’s decision.

 

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