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How to deal with a workers’ compensation denial

On Behalf of | Jun 16, 2022 | Workers' Compensation

If you had an injury at work, there is a good chance you filed a workers’ compensation claim. If there was a denial of the claim, you may be wondering what your next steps should be.

The first is to find out why there was a denial, as there are various reasons why it may have occurred. If you still feel like you have a valid claim, you can appeal the decision.

Common reasons for claim denials

FindLaw states that the reason for the denial should be in the denial letter. The most common reasons include:

  • You did not meet the deadlines: There is a deadline for when you must inform your employer about the injury and another for when you must file the claim.
  • Your employer challenges the claim: The employer may state that the accident happened due to horseplay, drug use or another disqualifying incident.
  • There is a dispute about whether the accident occurred at work: The accident must occur at the workplace or at a work event, and the employee must be on the clock.
  • You did not get the required medical treatment: To receive compensation benefits, you generally need to get medical treatment for the injury.

How to challenge a denial

The State of California Department of Industrial Relations discusses how you can challenge a claim denial. The first step is to file an Application for Adjudication of Claim in the county in which you live or received the injury. Once you receive the filing notice with your case number, you can request a hearing in front of a judge.

The judge will first attempt to settle the case between you and the claims administrator. If this does not occur, the judge will schedule a trial at which you can present and argue your case. The judge will usually make a decision within 90 days after the trial.