Workers' compensation in California is meant to aid workers financially when they have been injured or fallen ill on the job or due to their job. Sometimes, disputes arise. An employee may not agree with the employer and the employer's insurance, while the latter may not agree with the employee. Disputes can lead to delays and denials. Disputes can also be costly.
At Shawn Gol Law, P.C., our workers' comp lawyer, along with our team in Los Angeles can help. Contact us at (310) 900-0809.
Do You Have the Right to Workers' Compensation in California?
Many workers, prior to actually suffering a work-related injury, believe that if they are injured on the job their workers' compensation benefits will just kick right in without any further effort on their part. Unfortunately, this is not true.
Every state has a system for workers' compensation claims. While they may differ from jurisdiction to jurisdiction, all require an injured worker to take some action before they are able to receive their benefits. Also, a worker must be able to prove their injury. If not, benefits can be disputed or denied.
So, if a worker is injured on the job, they typically have a right to workers' compensation. That right, however, is not automatic and is dependent on state law.
Common Disputes in California Workers' Comp Claims
Once a worker has filed for benefits, two main types of disputes often arise. These disputes could involve (1) the insurer and commission or (2) the employer. For employees, it is important to know what could instigate a dispute so that they can proactively avoid them.
Insurer and Commission Disputes
Generally speaking, an injured worker has the burden to prove their injury meets all the criteria to enable them to recover benefits. Insurers and commissions on workers' compensation benefits often challenge claims on the basis that not all criteria have been met.
Common reasons insurers and commissions reject claims involve allegations that:
- The worker's injury pre-existed and is not connected to their employment
- The worker's injury was not sustained in the commission of their work-related duties
- The worker failed to notify their employer of the injury within the specified time frame
- The worker was not an employee and therefore not entitled to workers' compensation benefits
- The workers' injuries are not as serious as the worker claims
- The worker has failed to comply with requests, like getting a physical examination by an employer-based physician
Insurers and commissions may also refuse claims when they suspect fraud.
Employer Disputes
Employer disputes can crop up for a number of reasons. One of the most common reasons relates to premium costs. Successful claims for workers compensation benefits typically cause a significant increase in the premium costs for employers. As it affects their bottom line, employers push back on workers' comp claims. They will gather evidence to contest the payment of benefits.
Other employers will contest a claim for benefits because they doubt the validity of the claim. Typically, they either believe that
- The injury did not occur
- The injury did occur but is not as serious as claimed
- The injury did occur but is the fault of the worker.
Like insurers, employers may dispute workers' comp claims when they suspect fraud.
Contact a Workers' Comp Lawyer in Los Angeles Today
Workers' comp is designed to help workers injured on the job and who cannot work for a certain period of time. It is not designed to help workers who are injured but not due to their job. It's a costly program, and so tensions can rise when an employer or insurer suspects the injury does not qualify.
If you have questions about a workers' comp claim, At Shawn Gol Law, P.C., our workers' comp lawyer, along with our team in Los Angeles can help. Contact us at (310) 900-0809.