Practice Areas

Personal Injury Car and Automotive Accident Motorcycle Accident Truck Accident Dog Bite Slip and Fall Accident Wrongful Death Pedestrian Accident Construction Site Accident Premise Liability Workers Compensation Temporary Disability Medical Treatment Permanent Disability Cumulative Trauma Injury Award or Settlement Denied Claims Third Party Claims

Reasons for Claim Denial

‍Insufficient Evidence:
The insurer may argue there is not enough medical evidence linking the injury to the workplace.

‍Discrepancies in the Claim:
Inconsistencies between the injury report and medical records, or delays in reporting the injury, can lead to a denial.

‍Non-Work-Related Injuries:
The insurer may claim that the injury occurred outside of work or is related to a pre-existing condition.

‍Late Reporting:
Failing to report the injury promptly can result in a denial. California law typically requires employees to notify their employer within 30 days of the injury.

‍Employment Status Disputes:
If there is a question about whether the claimant was an employee or independent contractor, this can impact the claim’s validity.

Consider consulting with a workers' compensation Attorney
especially if the denial involves complex issues. An attorney can provide expert advice, represent you in proceedings, and help gather the necessary evidence to support your claim

Steps to Handle a Denied Claim

Review the Denial Notice:

Review the denial notice carefully to understand the reasons for the rejection and the evidence considered. This will help you address the issue effectively.

Request a Case Conference:

Contact the claims adjuster or your employer to discuss the denial. A case conference can sometimes resolve misunderstandings or provide an opportunity to submit additional information.

File an Application for Adjudication:

Submit an Application for Adjudication of Claim to the Workers' Compensation Appeals Board (WCAB). This formally begins the appeal process and allows for your case to be reviewed by a judge.

Attend a Mandatory Settlement Conference:

The WCAB will schedule a Mandatory Settlement Conference, where you and the insurer will discuss the possibility of settling the claim without a trial. This step can often lead to a resolution.

Prepare for Trial:

If the case is not settled during the MSC, it will proceed to trial. Gather all necessary documentation, including medical records, witness statements, and any other evidence supporting your claim. An attorney can help prepare and present your case effectively.

Appeal the Judge’s Decision:

If you disagree with the judge’s decision, you have the right to appeal. File a Petition for Reconsideration with the WCAB within 20 days of receiving the decision.

Resources and Support

California Department of Industrial Relations - Division of Workers' Compensation

If you disagree with the judge’s decision, you have the right to appeal. File a Petition for Reconsideration with the WCAB within 20 days of receiving the decision.

Workers' Compensation Appeals Board :

Offers guidance on filing an appeal and the adjudication process. WCAB Information

California Applicants' Attorneys Association :

CAAA is a professional organization that can help you find experienced workers' compensation attorneys. This guide explains denied claims under California's workers' compensation system and is not legal advice. For specific assistance, contact our knowledgeable attorneys.