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How to appeal a denied workers’ compensation claim

On Behalf of | May 6, 2024 | Workers' Compensation

When a worker in California suffers an injury on the job, they may file a workers’ compensation claim to receive benefits. However, sometimes these claims face denial by the employer or the insurance company. If this happens, the worker has the right to appeal the decision.

This process involves several steps and understanding them can help ensure the worker presents a strong appeal.

Understand why they denied your claim

The first step in appealing a denied workers’ compensation claim is to understand why they denied it. The denial letter should clearly state the reasons. Common reasons might include the claim not being filed on time, the injury not appearing to be work-related or insufficient evidence of the injury. Reviewing the denial letter carefully will help determine the right approach for the appeal.

File an application for adjudication of claim

To begin the appeal process, the worker must file an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board. This application starts the legal process and assigns a case number. You must file this application at the local WCAB office where the worker lives or where the injury occurred.

Submit a declaration of readiness to proceed

After filing the application, the next step is to submit a Declaration of Readiness to Proceed. This form requests a hearing before a workers’ compensation judge. The hearing will allow the worker to present their case as to why they believe the denial was unjust.

Prepare for the hearing

To prepare for the hearing, the worker should gather all relevant medical records, witness statements and other evidence that supports the claim. It might also be beneficial to consult with a workers’ compensation attorney who can represent the worker at the hearing.

Attend the hearing

At the hearing, the workers’ compensation judge will listen to both the worker and the employer or insurance company. Each party can present evidence and argue their case. The judge will then make a decision based on the law and the evidence presented.

Follow up after the hearing

If the judge decides in favor of the worker, the employer or insurance company will need to begin providing the benefits. If the decision is not favorable, the worker can file a petition for reconsideration. This petition asks the WCAB to review the case and is typically the final opportunity to overturn the denial.

By following these steps, workers can effectively manage their appeal and increase their chances of receiving the workers’ compensation benefits they deserve.