What to Do If Your California Workers’ Compensation Claim Is Denied

Facing a denial of your workers’ compensation claim in California can be a frustrating and confusing experience. Workers’ compensation is designed to provide financial and medical support to employees who have been injured on the job or suffer from a work-related illness. However, denials are not uncommon, and they can leave injured workers unsure about their next steps. Understanding what to do if your claim is denied and how to challenge the decision is essential for protecting your rights and obtaining the benefits you deserve.

California has a comprehensive workers’ compensation system, but it is also complex, involving a series of steps, documentation, and procedural requirements. When a claim is denied, it may be due to various factors, such as insufficient evidence, missed deadlines, or disputes about whether the injury is work-related. In this situation, it is important to remain calm and informed, as there are steps you can take to appeal the denial and continue pursuing the benefits you need.

David P. Myers

Managing Partner

Adam N. Stern

Attorney

Ann Hendrix

Attorney

Robert Kitson

Attorney

Justin Crane

Attorney

Doug Smith

Attorney

Jason Hatcher

Attorney

Morgan J. Good

Attorney

Alvin Ferrara

Attorney

Understanding Why Your Workers’ Compensation Claim Was Denied

The first step after receiving a denial is to understand the reason behind it. Workers’ compensation claims in California may be denied for various reasons, and it is crucial to review the denial letter carefully. The letter should explain why your claim was rejected. Common reasons for denial include lack of medical evidence supporting the injury, disputes over whether the injury occurred at work, failure to report the injury in a timely manner, or the employer or insurer arguing that the injury was pre-existing.

If you believe the denial was a mistake or unjust, you are not alone. Many workers face denials that are based on technicalities, incomplete information, or disputes over the facts of the case. It is important to gather all necessary documentation, such as medical records, witness statements, and reports that demonstrate the connection between your injury and your job. Once you understand why your claim was denied, you can begin the process of challenging that decision through the appeals system.

How to Appeal a Denied Workers’ Compensation Claim in California

If your workers’ compensation claim is denied in California, you have the right to appeal the decision. The appeal process is conducted through the state’s Workers’ Compensation Appeals Board (WCAB). Although the process can be complex, having a clear understanding of the steps involved can increase your chances of success.

The first step in appealing a denial is filing an Application for Adjudication of Claim with the WCAB. This document formally opens your case with the board and provides notice that you are disputing the denial. After filing the application, you will receive a case number and your case will be assigned to a workers’ compensation judge. It is important to ensure that all forms are completed accurately and submitted within the appropriate deadlines, as failure to do so can harm your chances of a successful appeal.

Next, you may need to attend a mandatory settlement conference, where you and the insurance company will attempt to reach a resolution. This is a pre-trial opportunity to discuss the case, and sometimes an agreement can be reached without going to a full trial. If no settlement is reached, the case will proceed to trial before a workers’ compensation judge, who will review the evidence and issue a decision. If the judge rules in your favor, you may be entitled to the benefits that were initially denied. However, if the judge upholds the denial, further appeals can be pursued through California’s judicial system.

I had some issues with my employer. I called a couple of law firms. Some called back and some did not. When David Myers returned my call I found him to be down to earth and personable. He was cognitive about my issues and his knowledge of Labor Law was exemplary. My issues were addressed and handled to my satisfaction. I will recommend David Myers and his law group to anyone who asks. Thank you David.”

- Ken Fretter

The Meyers Law Group is definitely the lawyer’s you want. We got absolutely misguided by another attorney firm and Maria helped us out and got us taken care of. Maria will take the time to completely understand your case and her knowledge is well beyond the many firms we sat with.Do not! I repeat, Do not! Use another firm without talking to The Meyers Law Group first.Thank you Maria for getting us the results we were expecting."

- Koa G.

I have hired David Myers for 2 cases. The first was a wrongful termination based on my request for a reasonable accommodation under ADA law. The second case involved an employer who reneged on a written job offer/acceptance. In both cases, David was knowledgeable about the laws, presented the case well, and was supportive of me. We prevailed on both cases. I would recommend David without hesitation."

- Anonymous

Gathering Evidence to Support Your Appeal

One of the most important steps in appealing a denied workers’ compensation claim is gathering evidence that supports your case. The initial denial may have been based on insufficient or unclear evidence, so strengthening your case with additional documentation is essential.

Medical records are a key component of any workers’ compensation case, and you will need to provide clear and detailed reports from healthcare providers that explain your injury or illness and its connection to your job. These records should include diagnosis, treatment plans, and any recommendations for ongoing care. If possible, obtain a written statement from your doctor or treating physician that explicitly states that your injury or condition is work-related.

In addition to medical evidence, other types of documentation may be helpful. Witness statements from coworkers, supervisors, or others who were present when the injury occurred can provide valuable support. If the injury occurred over time due to repetitive tasks, documentation of your work duties and how they contributed to your condition may be necessary.

It may also be helpful to keep a personal record of your injury, noting the dates, symptoms, and any conversations with your employer or coworkers about the incident. Detailed records can help corroborate your claims during the appeals process and demonstrate the seriousness of your condition.

The Role of Your Employer and Insurance Company in the Appeals Process

During the appeals process, your employer and their workers’ compensation insurance company will likely play a role in challenging or defending the original denial. The insurance company may argue that your injury did not occur at work, or they may present evidence that contradicts your claim.

It is important to be prepared for these challenges by gathering strong evidence and being ready to respond to any arguments or evidence presented by the insurance company. In some cases, employers may support the denial in order to avoid higher insurance premiums or to challenge the legitimacy of your claim. Having a clear understanding of your rights and the legal process will help you counter any arguments made by your employer or their insurance provider.

It is important to note that during the appeal process, you may be offered a settlement by the insurance company. Settlements can provide an immediate resolution, but they may also result in receiving less than the full benefits you are entitled to. If a settlement is offered, carefully consider the terms and consult with a legal professional before accepting. In some cases, it may be better to proceed with the appeal in order to receive full compensation.

Seeking Legal Help for a Denied Workers’ Compensation Claim

Navigating the appeals process for a denied workers’ compensation claim can be challenging, especially if you are dealing with a complex or disputed case. While it is possible to handle the appeals process on your own, seeking legal assistance from a California workers’ compensation attorney can significantly improve your chances of success.

An attorney who understands California’s workers’ compensation laws can help you gather evidence, prepare your case, and represent you at hearings or in settlement negotiations. They can also ensure that all forms and documents are completed correctly and submitted on time, helping to avoid any procedural errors that could negatively impact your case.

Workers’ compensation attorneys typically work on a contingency fee basis, meaning they do not charge any upfront fees and only get paid if you win your case. This arrangement can make legal representation accessible even if you are facing financial difficulties due to your injury or illness. Having an attorney on your side can give you peace of mind, knowing that you have someone advocating for your rights and working to secure the benefits you deserve.

Related Videos

Understanding Your Rights as an Injured Worker in California

It is important to remember that you have rights as an injured worker in California. Under the law, you are entitled to workers’ compensation benefits if you have suffered a work-related injury or illness. These benefits include medical treatment, temporary disability payments, and, in some cases, permanent disability compensation.

Even if your claim is initially denied, you have the right to appeal and present your case to the Workers’ Compensation Appeals Board. The appeals process is designed to ensure that injured workers have a fair opportunity to challenge decisions that they believe are unjust or incorrect.

You should also be aware that California’s workers’ compensation system protects you from retaliation by your employer. It is illegal for an employer to fire you, demote you, or otherwise punish you for filing a workers’ compensation claim or appealing a denial. If you experience any form of retaliation, it is important to seek legal advice and take action to protect your rights.

Having your California workers’ compensation claim denied can feel like a major setback, but it is not the end of the road. By understanding the reason for the denial, gathering strong evidence, and pursuing an appeal through the Workers’ Compensation Appeals Board, you can still fight for the benefits you are entitled to. The process may be complex, but with the right approach and support, you can overcome the challenges and secure the financial and medical assistance you need.

If your workers’ compensation claim has been denied and you are unsure of your next steps, The Myers Law Group, APC is here to help. Our experienced attorneys can guide you through the appeals process, protect your rights, and work tirelessly to ensure that you receive the compensation you deserve. Contact us today for a consultation and let us assist you in navigating this difficult time.