Why is a workers’ compensation claim denied?
When a claim is denied, it means that the claims administrator or committee believes that your injury is not covered by workers’ compensation. However, if you receive a letter notifying you that your claim was denied, you have the right to challenge the decision. When this happens, the ideal course of action is not to delay challenging the decision since there are deadlines to present the necessary documents.
We recommend that you evaluate the reason why the request was denied. This reason can be found in the denial letter. By knowing the reason, the action to challenge the decision will be more successful. Some of the most common reasons to receive a rejection of your workers’ compensation benefits are:
- The injury was not reported in time.
- The claim was not filed on time.
- Employer Dispute Claim: Your employer may claim that the accident occurred outside of work, that it was the result of rough play, or some other disqualifying reason.
- The injury is not compensable: injuries related to stress tend to be challenging to prove in many states. However, California does cover stress-related injuries.
- You did not get medical treatment: In most cases, you must obtain medical treatment to receive workers’ compensation benefits
- Insufficient evidence that the damage is work-related: It can be unclear whether a work injury occurred, but another medical examination and additional evidence may help your case.
In this type of legal proceeding, you have the option of representing yourself or hiring an attorney. If you contest the denial of your claim, your case will be heard by a Workers’ Compensation Administrative Law Judge (WCJ) at one of the division’s 23 field offices. Due to the complexity of the procedure, we recommend that you have the support of an experienced workers’ compensation attorney who knows the laws of the state of California well. Our team of experts can be reached at (855) 922-2812.