Receiving a denial for your workers’ compensation claim can be frustrating, but it does not mean the end of your case. You have options to challenge the decision and get the benefits you deserve. Understanding the next steps can help you move forward with confidence.
Review the denial letter
The first step is to carefully read the denial letter from the claims administrator. This document explains why your claim was denied. Common reasons include missed deadlines, insufficient medical evidence, or disputes over whether the injury is work-related. Identifying the reason for denial helps you determine how to proceed.
Gather supporting evidence
If a lack of medical proof caused your claim’s denial, additional documentation may help. Request medical records from your doctor, including test results and treatment plans. Witness statements from coworkers can also support your case. The more evidence you provide, the stronger your appeal will be.
File a claim petition
In California, you can challenge a denial by filing an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board (WCAB). This step officially starts the appeals process. After filing, you will receive a case number and a date for a mandatory settlement conference.
Attend the settlement conference
The settlement conference is an opportunity to resolve your dispute without a formal hearing. A judge will review your case and encourage both sides to reach an agreement. If a settlement is not possible, the case moves to trial before a workers’ compensation judge.
Prepare for trial
If your claim goes to trial, you will need to present medical records, expert testimony, and any other supporting evidence. The judge will review all information before making a final decision. If the ruling is not in your favor, you may have further appeal options.
Challenging a workers’ comp denial takes persistence, but the right steps can improve your chances of approval. Understanding the process and gathering strong evidence can help you fight for the benefits you need.