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What Should I Do If My Workers' Compensation Claim Is Denied?

If you are injured on the job, your claim should be covered under your employer’s workers’ compensation insurance. California requires all employers to carry insurance. Employers must also inform their employees of the coverage through a “notice to employees” poster in an obvious location.

Between 2013 and 2017, workers' comp denial rates have increased by 20%. Sometimes these denial reasons are legitimate. However, it is important to know that an insurance company makes money by collecting monthly premiums, not paying claims.

Companies have many reasons to reject claims, such as:

  • Late filing
  • Insufficient medical data
  • Injury sustained off the clock
  • Employer dispute
  • Damage doesn’t fit long-term injury definition
  • Errors in paperwork

While you may be surprised your workers’ comp claim was denied, don’t be disheartened. Many compensable situations are rejected. On average, 67% of denied worker's compensation claims become paid claims within a year.

Whether your claim was not filed within the statute of limitations or your employer disputed the evidence, we can help. Our workers’ compensation attorneys at Rodich Law can provide the diligent representation you need

Steps to Take if Your Claim Was Denied

Gather Necessary Documents

While filing a claim with an insurance company may be complicated, appealing its decision is even more so. Keep your letter of denial on file to help you with your case. The letter will often tell you the general reason your claim was rejected, which your lawyer can then use to defend your case in court.

Medical records, timesheets, photographs of your incident, and witness reports can provide evidence to support your claim. If new evidence has come to light or you believe the judge’s initial decision did not take all the evidence into consideration, you can provide the necessary documents to the appeals board.

File an Appeal

Once you realize your claim is denied, you should file an appeal. A workers’ comp appeal must be filed filed with a local Division of Workers’ Compensation (DWC) office. 

You must file a Petition for Reconsideration with your local district office, and describe the reasons for your appeal. The petition will be reviewed by the Workers’ Comp Appeals Board (WCAB). You will receive an answer within 60 days.

California only allows 20 days from the date you receive the denial letter to file an appeal, so it is important to act quickly.

File a Writ of Review

If you disagree with the board’s decision, you have 45 days to file a writ of review in the state appellate court. While the court cannot reverse any findings of fact made by the Workers’ Comp Appeals Board, it can review the case to determine if the board’s decision was reasonable based on the evidence. If the appellate court does not overturn the original decision, you can take your case to the California Supreme Court. However, it is rare for the court to hear a workers’ compensation case.

Get Help From Rodich Law

If your workers’ compensation claim has been denied, it is important to seek representation right away. At Rodich Law, we can help you file an appeal and keep you informed throughout the process. From gathering evidence to representing you against insurance companies, our Woodland Hills workers’ compensation lawyers can provide the legal assistance you need.

Contact our firm today for a free consultation.

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