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Navigating a denied workers’ compensation claim in California

On Behalf of | May 20, 2023 | Workers' Compensation

Workers’ compensation is a vital protection for California workers, providing benefits for those who have suffered job-related injuries or illnesses. However, it is important to note that not all workers’ compensation claims receive approval. In certain situations, claims may face denial.

If you find yourself in this situation, do not despair. Here are the steps you should take if your California workers’ compensation claim gets denied.

Understand the reason for the denial

The first step after receiving a denial is to understand the reason behind it. The denial letter should clearly state the grounds for rejection. Frequent causes may be failing to meet deadlines, disagreements on whether the injury occurred due to work or insufficient medical proof.

Request a copy of the claim file

Request a copy of your claim file from your employer’s insurance company. This file contains all the information used to evaluate your claim. Review it carefully for any errors or missing information that might have led to the denial.

Gather additional evidence

If the denial of your claim is due to a lack of medical evidence, collect additional evidence to strengthen your case. This might include medical records, doctor’s notes and any other documentation that verifies the extent of your injuries and their connection to your work.

File an appeal

In California, you have the right to appeal a denied workers’ compensation claim. To do this, you must file an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board. This starts the legal process to dispute the denial.

Attend the mandatory settlement conference

Once you file an appeal, the WCAB will schedule a mandatory settlement conference. During this conference, you and the insurance company will discuss the claim and try to reach a settlement. If a settlement is not reached, the case will proceed to trial before a workers’ compensation judge.

While the process for filing an appeal can be complex, taking these steps can increase the chances of a favorable outcome.