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Why Your Employer is Fighting Your Workers' Comp Claim

You've been injured or gotten sick on the job. You filed a workers' comp claim the way you should. But, now your employer is fighting your claim. Why is that happening? And, what can you do about it? In this blog post, we try to answer those questions and give some suggestions for what you can do to recover the money you deserve after getting hurt or sick at work.

Quick Overview of California Workers' Comp Laws

This guidebook from the California Department of Industrial Relations (CDIR) gives an excellent explanation of workers' comp law in California. It's written to answer the questions you may have as an injured worker. Just in case you don't have the time to read it right now, here are the basics: 

  • Every employer in California is required to carry workers' compensation insurance.
  • An employer cannot make an employee cover the cost of workers' compensation insurance. 
  • Workers' comp covers your medical expenses for any injury you get at work, even if you don't have to miss time from work because of it. 
  • Workers' comp also pays temporary disability benefits for time you miss from work while you recover, for certain permanent disabilities that prevent you from returning to work, and for death benefits if a family member died on the job. 
  • You are entitled to workers' comp benefits no matter who was at fault for your on-the-job injury. 
  • Workers' comp covers full-time, part-time, and temporary workers, whether or not they are legal residents of the United States.
  • An employer cannot punish you, fire you, or otherwise retaliate against you for requesting workers' comp benefits.
  • To be eligible for workers' comp benefits, it is important to report workplace injuries immediately and to seek appropriate medical care from approved doctors.
  • Workers' comp benefits are usually, but not always, the only compensation you are entitled to receive from your employer after a workplace injury or illness. (You may be able to recover compensation from others, however.)

The California workers' comp laws try to make it easy for workers to obtain the benefits they deserve, but it doesn't always work that way. If any part of the workers' comp laws confuses or intimidates you, contact an experienced workers' comp attorney. 

Reasons Your Employer May Fight Your Workers' Comp Claim

If your employer fights your workers' comp claim, you can bet the reason has something to do with money. Workers' comp is a type of insurance. Just like any other kind of insurance, your employer has to pay premiums, and the amount of those premiums depends, at least in part, on how many claims your employer's workers' comp policy has paid out in the past. The more claims, the higher the premiums, and the higher the premiums the lower your employer's profits. 

Employers also often worry that your claim will reveal ongoing safety violations at the company. Those safety violations could cost your employer not just in higher premiums, but also in fines government inspectors. 

So, that's the "bottom line" reason why your employer may want to fight your claim. But, your employer also knows it's illegal to fight a claim just because his premiums will rise. Instead, your employer may try to point to some other reason why claims shouldn't be paid. These could include:

  • You didn't notify your employer in time. The workers' comp law gives workers' a broad guarantee of financial protection, so long as you notify your employer of an injury within 30 days of getting hurt or sick. As the CDIR emphasizes on its website: "If you don't report your injury within 30 days, you could lose your right to receive workers' compensation benefits." 
  • You didn't see an approved doctor. Under California law, workers' comp insurance will only pay medical expenses to doctors who have been pre-approved by your employer. They may also pay for your own doctor, so long as you have "pre-designated" your doctor as someone who is approved. (The CDIR guidebook linked above explains how to do that.) 
  • You didn't get injured on the job. Workers' comp pays benefits for workplace injuries. One reason your employer might fight your claim is if he believes you didn't actually sustain an injury on the job. This can be a confusing issue sometimes. For example, your employer might have the mistaken impression that aggravating a preexisting injury doesn't entitle you to benefits under workers' comp (it does). Or, your employer may reject the idea that a long-term exposure to workplace conditions caused you to get sick. 
  • You don't need the benefits you're claiming. Sometimes, employers dispute that you're really as hurt as you say. They may claim you can return to work sooner than you believe you can, or that you aren't permanently disabled, or that the medical treatments you want to be covered by workers' comp aren't necessary.

How to Fight Back

Getting the workers' comp benefits shouldn't be difficult. If you employer is giving you a hard time about them, you may benefit from seeking legal advice from a skilled and experienced workers' comp attorney. An attorney can:

  • Help you gather evidence and documentation of your injury.
  • Locate and facilitate you consulting with a medical professional who can confirm the nature of your injury and any disability, and the type of treatment you need to reach your maximum recovery.
  • Negotiate with your employer's workers' comp insurance company about the level of benefits you deserve. 
  • Evaluate whether there are other parties who may owe you compensation for your injuries. These could include manufacturers of defective work equipment or toxic materials, or third parties who worked on your job site.
  • In rare cases, your employer may also have direct liability to you, such as if your employer intended to cause you harm, or if your employer is fighting your claim to retaliate against you or to warn other employees not to file claims. 

If you have suffered an injury at work and your employer is fighting back against your workers' comp claim, don't wait to find the help you need to recover the benefits you're entitled to receive under California law. 

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Next: Seeking Workers Comp for Strain and Repetitive Motion Injuries.