Receiving a denial for a workers’ compensation claim can feel overwhelming. When this happens, you can file an appeal to challenge the decision and seek the benefits you may deserve.
Understanding how the appeals process works is important for anyone facing a denied claim.
Why workers’ compensation claims get denied
California workers’ compensation claims may face denial for several reasons. Insurance companies may argue that the injury did not happen at work or that the worker did not report the injury within the required time frame. Sometimes, a claim may face denial if there is insufficient medical evidence to support the injury. Regardless of the reason, the appeals process gives workers a chance to present their case and correct any misunderstandings.
The steps to appeal a workers’ compensation denial
The appeals process in California involves several key steps. First, you must file an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board. This form officially starts the appeal and assigns a case number.
Next, you can request a Mandatory Settlement Conference. At this conference, both parties meet to discuss the case and attempt to resolve the dispute. If you cannot reach an agreement, the case moves to trial before a workers’ compensation judge.
During the trial, you have the opportunity to present evidence, such as medical records and witness testimony, to support your claim. The judge reviews the evidence and issues a decision. If you disagree with the judge’s decision, you may request a review by the Workers’ Compensation Appeals Board.
Important deadlines to follow
California law sets strict deadlines for appealing a workers’ compensation denial. You must file the Application for Adjudication of Claim within one year from the date of injury or the date you became aware of a work-related injury. Missing deadlines can result in losing the right to pursue benefits.
The appeals process can take time and requires careful attention to detail. Filing an appeal means gathering strong evidence, meeting deadlines and following legal procedures. Understanding each step will help you protect your rights and improve your chances of receiving the benefits you need.