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Milena Velilla

Can you challenge denied workers’ compensation claims?

On Behalf of | Aug 4, 2022 | Workers' Compensation

Injured employees are almost always surprised or shocked to learn that their workers’ compensation claim ended in a denial of benefits. Unfortunately, denials can and do occur for several different reasons.

Sometimes, the employee made a mistake when filing a claim, but denials also arise if a claims adjuster or your employer feels your injury is ineligible for coverage. We want you to know you may contest a denied workers’ compensation claim.

How does it work in California?

Your first step is filing an Application for Adjudication of Claim with your local worker’s compensation appeal office. Upon receipt, it will give you a case number for use with your appeal. Filing this document establishes jurisdiction and gives the workers’ comp appeal board the authority to resolve your dispute.

Next, you must file a Declaration of Readiness to Proceed before an administrative law judge will hear your appeal. It is vital to make sure you gather evidence to present at the hearing. Examples include:

  • Medical evidence: Official diagnostic reports, treatment records, x-rays and evidence confirming your medical eligibility
  • Employment evidence: Timesheets or cards, official injury report (to the employer) and additional documents proving the injury is work-related

Every worker injured on the job has the right to seek workers’ compensation, including undocumented workers. All whose claim was denied also have the right to appeal the board’s decision.

Unfortunately, it is often challenging for those without a legal background to contest a denial of workers’ comp benefits. We recommend learning more about worker’s compensation and appealing denials to facilitate the most favorable outcome. Experienced legal guidance can be invaluable.