Workers' Comp Claim Denied in Van Nuys? Get Help Now

Why Insurance Companies Deny Claims in Van Nuys

Denials come in many forms, but the underlying motivation is always the same: the insurance company wants to pay as little as possible. Here are the denial grounds we see most frequently in Van Nuys cases.

"Your Injury Is Not Work-Related"

The most common denial. The insurer sends you to their doctor, who concludes your condition is due to aging, a pre-existing problem, or activities outside of work. This is especially prevalent in Van Nuys cases involving auto mechanics on Van Nuys Boulevard — insurers argue that the mechanic's shoulder or back problem comes from weekend hobbies rather than years of physically demanding shop work. It is also common with government office workers whose cumulative trauma from typing is attributed to personal computer use at home. Overturning these denials requires independent medical evidence from a qualified evaluator who conducts a thorough examination and reviews your complete job history.

"You Did Not Report in Time"

LC section 5400 requires you to report a specific injury within 30 days. If the insurer claims you missed this deadline, they may deny the claim. But California law provides several exceptions: the employer had actual knowledge of the injury, the delay was caused by the employer's failure to provide the DWC-1 form, or the late reporting did not prejudice the insurer. Many Van Nuys workers, particularly in small auto shops and restaurants where record-keeping is informal, report injuries verbally but do not create written documentation. When the employer later claims no report was made, a lawyer can develop evidence showing the employer knew about the injury.

"You Had a Pre-Existing Condition"

Insurers love this one. You have an old MRI showing some disc degeneration, or a prior medical record mentioning knee pain, and the insurer uses it to deny the entire claim. But California law does not require you to be in perfect health before you were hired. Under the legal doctrine of apportionment, if work aggravated or accelerated a pre-existing condition, the resulting disability is at least partially compensable. Complete denial based on a pre-existing condition is almost always an overreach that can be challenged successfully.

"You Were Not an Employee"

This denial hits workers in Van Nuys's gig economy, small auto shops that pay workers in cash, and construction sites where laborers are hired day-to-day without formal documentation. The insurer or uninsured employer claims the worker was an independent contractor, not an employee, and therefore not covered by workers' comp. California's ABC test under LC section 2775 presumes workers are employees unless the hiring entity proves otherwise. Many of these denials crumble under legal scrutiny.

"The Injury Is Not Covered"

Some denials target specific body parts or conditions. The insurer accepts that you were injured at work but denies that a particular body part is involved, or denies that your psychological condition (anxiety, depression, PTSD) is connected to the industrial injury. Body-part disputes require medical evidence. Psychiatric injury claims under LC section 3208.3 require showing the employment contributed at least 51 percent to the psychiatric condition — or only 35 percent if the injury resulted from a sudden and extraordinary employment condition.