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What to Do if Your Workers Comp Claim Is Denied in California? 2024

Learning that your workers’ compensation claim has been denied can be upsetting due to the practical impact on your ability to support yourself and your family. Take comfort in knowing that a denied claim doesn’t always mark the end of the workers’ comp claim process. A qualified California workers’ compensation attorney could help you pursue this type of appeal.

In California, a denied claim can be appealed through a structured process overseen by state law. More specifically, you will need to take your case to the state’s Workers’ Compensation Appeals Board (WCAB).

Understanding a Workers’ Compensation Claim Denial

Having your workers’ comp claim denied when you are struggling and need financial support might leave you feeling hopeless, but the appeals process could give you a second chance to present your case and access the benefits you rightfully deserve.

Before doing so, it’s crucial to understand exactly why your initial claim was denied. This may allow you and your California workers’ compensation attorney to craft an airtight strategy to guide the appeals process to a better outcome than the initial claim.

When California workers’ compensation claims are denied, state officials will send a letter specifying the exact reasons for the denial. This will be extremely useful to you and your attorney as you develop a strategy for seeking an appeal, as you will want to be sure to adequately address every point in the denial letter. However, reviewing this denial letter should only be the beginning when it comes to pre-appeal preparation.

In California, workers’ compensation records are public. This makes it easy to do research on claims similar to your own, but it can also be helpful when you need to obtain a copy of your own case records. After you’ve equipped yourself with all documentation related to your claim and its denial, you should sit down with your attorney and go over every aspect of the claim and denial in detail so that you can begin building an effective appeal strategy.

What Are the Steps of a Workers’ Compensation Appeal?

A workers’ compensation case that goes to appeal can involve many stages, but the process of such a case usually follows these general steps:

  1. The Injury – A Californian worker is injured or falls ill in the course of doing their job. They believe the injury or illness to be directly related to their work.
  2. Seek Acute Medical Care – If your job-related injury requires first aid or even hospitalization, make sure you see to your immediate medical needs before anything else. If possible, make sure your employer is fully aware of the situation, but do whatever you need to do to take care of yourself first and foremost, especially if there are life-threatening injuries involved.
  3. Employer Notification – If you intend to seek workers’ compensation benefits, you are obligated by law to promptly report your injury to your employer. In fact, this notification is what really begins the official workers’ compensation claim process.
  4. Consult With a Workers’ Comp Attorney – Seek legal counsel promptly once you have taken care of your acute medical needs and your responsibility to notify your employer of the incident. A reputable California workers’ compensation attorney can assess the merits of your claim and provide valuable insights throughout the process.
  5. Initial Claim – By this point, the injured worker should have received a DWC-1 form, which they must fill out completely and accurately. If you have been injured on the job, note that this form should be requested directly from your supervisor at work at the same time you notify them of your injury.Your employer may give you the DWC-1 form immediately or may send it to you in the mail, but they are legally required to provide one in a prompt fashion by one means or another. It’s a good idea to have an attorney overseeing and advising this step, as issues with the initial claim paperwork are one common reason for workers’ comp cases to end in denials and long appeals processes.
  6. Continue Seeking Medical Care – Continue getting treatment for your injuries if necessary. Even if your claim is denied initially, seeking professional medical attention establishes a record of your injuries.
  7. Denial – If your claim is denied by your employer’s insurance carrier, you will be notified of the decision.
  8. Filing the Appeal – When a workers’ compensation claim is denied, the injured worker may then choose to file an Application for Adjudication of Claim form to initiate the process of reviewing the case.
  9. Formal Hearing – Cases that cannot reach a smooth resolution through settlements or mediation can proceed to a formal hearing with a workers’ compensation judge. Here, you will hear from your workers’ comp attorney that both of you will present your case, along with all available or updated evidence, and hear the judge’s decision.

FAQs

Q: How Do I Appeal a Workers’ Comp Denial in California?

A: To appeal your workers’ claim decision, you will file an Application for Adjudication of Claim so that the state Workers’ Compensation Appeals Board (WCAB) can begin a review of your case. Note that this application, much like the initial claim, must be filed within statutory time limits.

Q: What Happens After an Employee’s Worker Compensation Claim Is Denied?

A: If your workers’ compensation claim has been denied, and you have not yet enlisted the services of a qualified attorney for legal advice, a good next step is to contact a California workers’ comp attorney to begin the process of developing a winning appeal strategy. You and your lawyer can review the reasons for the denial and attempt to address them in an appeal so that you can get the compensation you need.

Q: How Long Does Workers Comp Have to Accept or Deny a Claim in California?

A: In the state of California, your employers’ workers’ compensation insurance carrier has 90 days to accept or deny the claim. Extensions to this timeline may be granted in cases that call for extensive investigation. If your claim is denied, you could still appeal the decision to potentially have it reversed.

Q: Are Denied Workers Comp Claims OSHA Recordable?

A: While claim denials themselves are not necessarily a matter of OSHA record, the incident that caused the injury in question might still require OSHA reporting if it meets their criteria. The concept of OSHA reporting is separate from the status of your workers’ compensation claim, although it stands to reason that incidents meeting the OSHA definition of a workplace injury will often be eligible for workers’ compensation benefits.

Canlas Law Group – Your CA Workers’ Compensation Attorneys

If your workers’ compensation claim has been denied, but you’re unable to work, and in dire need of financial support, we can help. The talented workers’ compensation team at Canlas Law Group is ready to help you implement an airtight strategy for seeking an appeal and reversal. Contact us today to begin the appeal process with a no-pressure consultation.

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