Suffering an on-the-job injury or illness could put you out of work for weeks or longer. If you filed a workers’ compensation claim in California that was denied, you should take immediate action.
Reasons for workers’ compensation claim denials
Sometimes, a workers’ compensation claim is denied. The most common reasons for denial include the following:
- Your injury was not caused by the duties directly related to your job.
- You suffered your injury while working for another company.
- You did not require medical treatment to recover from your injury.
- You do not need to take time off from work due to your injury.
If none of these scenarios actually apply to your situation, you have the right to appeal the denial.
How can you appeal the denial of your workers’ comp claim?
If your claim is denied and you wish to appeal it, you should immediately act. Waiting increases the chances that the denial of your workers’ comp claim will stand. You should complete and file an Application for Adjudication of Claim form, which includes your original claim. It should provide you with a workers’ compensation case number as well. Afterward, you can file a Declaration of Readiness to Proceed (DOR) form to request a hearing before the Workers’ Compensation Appeals Board (WCAB).
During your hearing, you will need medical evidence to back up your claim that your injury was work-related. You may be required to see a doctor for an evaluation. If you are dissatisfied with the findings from this initial doctor, you have a right to request another evaluation by another doctor. The insurance company is also permitted to request another medical examination by a different doctor.
If the hearing doesn’t see a settlement reached, you go to trial before a judge. The judge will issue a decision between 30 and 90 days. If you or the insurance adjuster disagrees, you can file a Petition for Reconsideration.
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