What to Do if My Workers’ Compensation Claim Is Denied in California?

If your workers’ compensation claim is denied, you still have options. California law provides a process for challenging the denial and pursuing the benefits you need.

Contact Orange County workers’ compensation attorneys at Aegis Law Firm to discuss your legal options today.

Steps to Take if Your Claim Is Denied

1. Review the Denial Letter

Carefully read the denial letter to understand the specific reasons your claim was denied. The letter will also include instructions for appealing the decision and the deadline for filing your appeal.

2. Consult a Workers’ Compensation Attorney

A skilled Orange County employment lawyer who specializes in workers’ compensation can evaluate your case, identify errors in the denial, and guide you through the appeals process. They can also gather evidence, represent you in hearings, and negotiate with insurance companies on your behalf.

3. File an Application for Adjudication of Claim

To formally appeal the denial, you must file an Application for Adjudication of Claim with the California Workers’ Compensation Appeals Board (WCAB). This step opens your case with the WCAB and allows you to request a hearing.

4. Request a Hearing

Once your claim is filed, you can request a hearing before a workers’ compensation judge. This is done by filing a Declaration of Readiness to Proceed (DOR). The judge will review the evidence and hear arguments from both sides.

5. Gather Additional Evidence

To strengthen your appeal, collect any missing or additional evidence, such as:

• Medical records and reports from your treating physician.
• Witness statements from coworkers or others who can verify your injury.
• Documentation of the work conditions that contributed to your injury.

Your attorney can help identify the evidence needed to counter the reasons for the denial.

6. Attend the Hearing

During the hearing, you and your attorney will present your case to the judge. The employer or insurer will also present their side. The judge will then issue a decision based on the evidence and testimony provided.

7. Appeal the Judge’s Decision (If Necessary)

If the judge denies your claim after the hearing, you have the right to appeal the decision to the WCAB Reconsideration Unit. Further appeals can be made to the California Court of Appeal if necessary.

Common Reasons for Workers’ Compensation Claim Denials in California

Understanding why your claim was denied is the first step in addressing the issue. Common reasons for denial include:

• Lack of Evidence: Insufficient medical records or proof that the injury occurred at work.
• Disputes About the Injury: The employer or insurer may argue that the injury is not work-related or that it resulted from a pre-existing condition.
• Missed Deadlines: Failing to report the injury within the required time frame or submitting the claim late.
• Disputed Coverage: The employer or insurer may claim that you were not an eligible employee at the time of the injury.

The denial letter you receive should outline the reasons for the decision.

Tips for Improving Your Chances of Success

Act Quickly

Missing deadlines can jeopardize your ability to appeal.

Be Thorough

Provide detailed evidence to support your claim, including medical reports and workplace documentation.

Work with Our Orange County Workers’ Compensation Lawyers

An experienced Orange County workers’ compensation attorney can help you navigate the complexities of the appeals process from beginning to end, advocating for your rights. With their experience and knowledge, the chances of approval significantly increase. Call us at (949) 379-6250 to schedule a free consultation today.