Receiving a denial for your workers’ compensation claim can be frustrating and stressful, especially when you’re facing medical bills and lost wages. What should you do if your workers’ compensation claim is denied in California?
At Scher, Bassett & Hames, we have helped countless injured workers fight claim denials and secure the benefits they deserve. Below, we outline the key steps to take if your workers’ compensation claim is denied.
Why Are Workers’ Compensation Claims Denied in California?
What are the common reasons for a workers’ compensation claim denial? Workers’ compensation claims in California may be denied for a variety of reasons, including missed deadlines, insufficient medical evidence, or employer disputes.
Common Reasons for Denial:
- Failure to report the injury on time – Claims must be reported within 30 days of the injury.
- Lack of medical evidence – Insufficient documentation linking the injury to work.
- Employer disputes the claim – The employer may argue the injury did not happen on the job.
- Missed filing deadlines – Workers’ compensation claims must be filed within one year of the injury.
- Pre-existing conditions – Insurers may claim the injury was not work-related.
- Injury not covered under workers’ compensation – Some claims are denied because the injury is not considered work-related under California law.
Understanding why your claim was denied is the first step to challenging the decision.
Steps to Take If Your Workers’ Compensation Claim is Denied
What should you do immediately after a workers’ compensation denial? If your workers’ compensation claim is denied, follow these steps to challenge the decision and secure your benefits.
1. Review the Denial Letter
- The letter will outline the reason(s) for the denial.
- Note any missing documentation or disputed facts.
- Identify deadlines for appealing the decision.
2. Gather Additional Evidence
- Obtain medical records showing the extent of your injury.
- Collect witness statements from coworkers who saw the accident.
- Secure workplace incident reports that document the injury.
- Seek an independent medical evaluation if needed.
3. File a Request for Reconsideration
- If the denial was due to a lack of documentation, you may submit additional evidence to the claims administrator for reconsideration.
- Keep copies of all correspondence for your records.
4. File an Appeal with the Workers’ Compensation Appeals Board (WCAB)
- Complete and submit Application for Adjudication of Claim through the WCAB.
- Request a hearing before a workers’ compensation judge to review your case.
- Consult with a workers’ compensation attorney to strengthen your appeal.
5. Attend the Mandatory Settlement Conference (MSC)
- The MSC is a pre-trial hearing to discuss possible settlements.
- If a settlement is not reached, the case moves forward to trial.
6. Prepare for a Workers’ Compensation Trial
- Present medical evidence, expert testimony, and witness statements.
- The judge will issue a decision on your case.
- If unsuccessful, you can file a petition for reconsideration.
Appeal Steps and Deadlines in California
What are the steps to appeal a denied workers’ comp claim and when are the deadlines?
Use the following timeline to stay on track if your claim was denied:
| Step | Deadline | Action |
|---|---|---|
| Report Your Injury | Within 30 days of the incident | Notify your employer in writing of the injury or illness |
| File Your Initial Claim | Within 1 year of injury | Submit the workers’ compensation claim form (DWC-1) to your employer |
| Receive Denial Letter | Typically within 14 days | Insurer sends a written notice of denial, stating the reason |
| File Application for Adjudication of Claim | ASAP after denial | Submit to the WCAB to open an official case |
| File a Petition for Reconsideration (if appeal is denied) | Within 20 days of WCAB decision | Requests a higher review of the judge’s decision |
Missing any of these deadlines could limit your right to benefits. Always document your steps and consult legal counsel early in the process.
How Long Do You Have to Appeal a Denied Claim in California?
What is the deadline to appeal a workers’ compensation denial? In California, you have one year from the date of injury to file a claim and up to 20 days to appeal a denied claim through the WCAB.
Acting quickly is critical, as missing the deadline could result in losing your right to benefits.
What Happens After a Workers’ Comp Appeal is Approved or Denied?
What are the next steps after your workers’ comp appeal decision in California?
If your workers’ compensation appeal is approved, you will begin receiving the benefits previously denied. This may include retroactive payments for temporary disability, medical treatment coverage, or permanent disability compensation. The insurance company will be legally required to comply with the ruling.
If your appeal is denied, you still have legal options. You may file a Petition for Reconsideration with the California Workers’ Compensation Appeals Board (WCAB) within 20 days of the decision. This petition allows the WCAB to review potential legal errors or overlooked evidence. If that also fails, you can appeal to the California Court of Appeal.
Working with an experienced workers’ comp attorney after an appeal ruling—whether favorable or not—can help ensure you understand your rights and options under California law.
What Benefits Can You Receive After a Successful Appeal?
If your appeal is successful, you may receive:
- Medical treatment coverage – Paid by your employer’s workers’ compensation insurance.
- Temporary disability benefits – Wage replacement while recovering.
- Permanent disability benefits – Compensation for long-term impairments.
- Vocational retraining – If unable to return to the same type of work.
Can You Reapply After a Workers’ Compensation Denial?
Can a denied workers’ comp claim be reopened in California?
Yes. In California, you may reopen or reapply for workers’ compensation benefits under certain conditions. If your initial denial was due to missing documentation or lack of medical evidence, you may submit new supporting documents and request reconsideration from the claims administrator or WCAB.
Additionally, if your condition worsens or new medical findings emerge, you can file a Petition to Reopen within five years of the date of injury. This allows you to request additional benefits due to a change in your medical status.
A skilled attorney can evaluate your denial, identify any new evidence, and help you reinitiate the claims process correctly to improve your chances of approval.
Don’t Let a Denied Claim Stop You – Get Legal Help Now
If your workers’ compensation claim was denied, you still have options. An experienced workers’ compensation attorney can help you challenge the denial and fight for the benefits you deserve.
Call Scher, Bassett & Hames today at 408-739-5300 for a free consultation. We are ready to protect your rights and maximize your compensation.
Resources:
For more information on appealing denied workers’ compensation claims in California, visit:
- California Division of Workers’ Compensation – Claim Dispute Process
- California Labor Code – Workers’ Compensation Appeals
- State Bar of California – Legal Help for Workers’ Compensation
- Occupational Safety & Health Administration (OSHA) – Workplace Injury Rights
Further Reading:
- How Long Does It Take for a Workers Comp Settlement in California?
- Are Workers’ Compensation Benefits Taxable in California?
- How Much Do Workers Comp Lawyers Charge in California?
