Helping you when the insurance company denies your claim

What to do When Your Claim is Denied

Receiving a "Notice of Denial" from an insurance company is one of the most stressful moments for an injured worker. It feels like the system has turned its back on you. What you must know from the outset is that workers' compensation insurance companies will use any excuse to deny a claim.  The adjuster's job may be to administer your claim, but ultimately, the insurance company's profitability turns on minimizing the cost of each claim.  The denial is the primary tool of cost containment.

At Ryan D. Kayrell, PC, I specialize in navigating the complex legal steps required to challenge a denial. You don't have to face the insurance company's legal team alone.

Why Claims are Denied

Denials fall into three broad categories: legal denials, factual denials, and medical denials.

Legal Denials: Procedural Barriers

These denials are based on the rules and timelines of the California Labor Code rather than the injury itself. Common examples include:

* Statute of Limitations: The insurance company claims you waited too long to report the injury or file your claim.

* Post-Termination Defense: They argue your claim is barred because you filed your claim after you were terminated.

Factual Denials: "AOE/COE" Disputes

This is a very common denial where the insurance company disputes the basic facts of how or where the injury happened. In legal terms, they argue the injury did not Arise Out of Employment (AOE) or occur in the Course of Employment (COE).

* Off-Site Injuries: They claim you were on a personal errand or "going and coming" to work rather than performing job duties.

* Lack of Witnesses: They claim there is no evidence the incident actually occurred as described.

Medical Denials: Disputing the Injury

Even if they admit you were at work, the insurance company may deny the claim based on medical findings.

* Pre-Existing Conditions: They argue your pain is caused by an old injury or "normal wear and tear" unrelated to your current job.

* Lack of Medical Evidence: Their initial doctor (often a "company doctor") claims there is no objective finding of an injury.

How We Fight a Denial

To overturn a denial, we immediately start conducting discovery. This involves:

1. Filing an Application for Adjudication: Formally bringing your case before the Workers' Compensation Appeals Board (WCAB).

2. The QME Process: Selecting a neutral Qualified Medical Evaluator to provide an independent opinion on your injury.

3. Depositions and Evidence: Gathering witness testimony and medical records to prove the facts of your case.

4. The MSC and Trial: Attempting to resolve the dispute through negotiation or, if necessary, a formal trial before a judge.

Personal Representation Matters

Challenging a denial requires a deep understanding of the California Labor Code and recent court decisions. When you hire me, you get a dedicated attorney who personally handles every step of the litigation process. I know the insurance company's tactics, and I know how to build a case that protects your future.