What happens to my medical bills when workers’ comp is denied?

While a claim is being investigated, medical treatment provided under the claim is limited to a total of $10,000. If the claim is then denied, the bills become part of the dispute. Don’t ignore bills or collection notices. Bring them to your free consultation so we can see what’s owed and who should pay it.

What is the 90-day rule in California workers’ comp?

If your employer’s claims administrator doesn’t accept or deny your claim within 90 days after you give the completed claim form to your employer, the law presumes your injury or illness was caused by work. That presumption can be hard for the insurer to overcome, so the filing date and any delay notices matter. Keep copies of everything you submit.

How hard is it to win a workers’ comp case?

It depends on the evidence. The central question is whether your injury or illness is work related, and the medical record carries a lot of weight. Cases get harder when reports are late, medical records are thin, or doctors disagree. A lawyer can line up the medical evidence and handle the hearing.

Denied Workers' Comp Claim in California? What to Do Next

Q: What happens if my workers’ comp claim is denied?

A denial isn’t the final word. You can dispute it and have the case decided by a workers’ compensation judge. Keep the denial letter, your medical records and any witness names. Rodich Law reviews denials for free and explains whether the reasons hold up and what evidence could change the outcome.

A denied workers' comp claim can feel like a door slamming shut. You're hurt, you may be missing paychecks, and now the insurance company says it won't pay. But a denial is not the final word. It's the insurance company's decision, and in California you have the right to challenge it.

This page explains why claims get denied, what to do right away, and how to fight back. Rodich Law helps injured workers with denied claims across Southern California, including Los Angeles, Ventura, Orange, Riverside and San Bernardino counties, from our office in Woodland Hills. Call (818) 888-3000 for a free review of your denial.

Why Was My Workers’ Comp Claim Denied?

Insurance companies deny claims for many reasons. Some are real problems, and many can be fixed. The most common reasons include:

You reported the injury late. The insurance company may argue the injury didn’t happen at work because you waited.
Not enough medical proof. Your medical records don’t clearly connect your injury to your job, or don’t show how serious it is.
Gaps in treatment. If you missed appointments or waited to see a doctor, the insurance company may say you’re not really hurt.
They say it didn’t happen at work. For example, they claim you were off the clock, on a personal errand or commuting.
They blame an old injury. The insurance company says your problem comes from a past injury or aging, not your job.
They say you’re not an employee. Your employer calls you an independent contractor, even if the law says you’re an employee.
No witnesses. No one saw the accident, so the insurance company questions your story.
You filed after being fired or laid off. California has special rules for these claims, but many can still succeed.
Paperwork problems. A missing signature, wrong date or missing claim form can lead to a denial.

The reason for your denial letter tells you what you need to prove. That’s the starting point for fighting back.

Can My Employer Deny My Workers’ Comp Claim?

Usually, your employer doesn’t decide. In California, almost every employer must carry workers’ comp insurance, and in most cases the insurance company or its claims administrator decides whether to accept or deny your claim. Your employer can share its side of the story, and sometimes it disputes your claim, but it can’t simply refuse to let you file.

Who Decides Depends on How Your Employer Is Covered

Insured employers. Most businesses buy a workers’ comp policy, from a private insurance company or from State Compensation Insurance Fund (State Fund), California’s state-run insurer. The insurer’s adjuster decides your claim.
Self-insured employers. Some large employers and many public agencies pay their own claims instead of buying insurance. In Southern California, that often includes counties, cities and school districts. A claims administrator, sometimes an outside company, handles the claim for them. The same rules and deadlines apply.
Uninsured employers. If your employer broke the law by not carrying workers’ comp, you may still get benefits through a state fund for injured workers. You may also be able to sue your employer directly.

Not sure who covers your employer? California employers must post a notice at work listing their workers’ comp insurer. You can also look up an employer’s coverage online through the state’s insurance rating bureau.

What Your Employer Must Do Under California Law

Give you a claim form (DWC-1) within one working day after you report an injury
Send your completed claim form to the insurance company within one working day of getting it back from you, and give you a dated copy
Authorize medical treatment within one working day after you turn in the form, up to $10,000 while your claim is being decided
Not fire, punish or threaten you for reporting an injury or filing a claim

Warning Signs Your Employer Is Getting in the Way

Tell a lawyer if your employer:

Refused to give you a claim form, or said you “don’t qualify”
Told you to use your own health insurance instead of filing a claim
Offered to pay your medical bills “off the books”
Delayed sending your claim to the insurance company
Cut your hours, moved you to a worse job or threatened you after you got hurt

These can hurt your claim if you wait, and some are illegal. Not sure your injury is covered at all? Read do I qualify for workers’ comp.

The 90-Day Rule in California Workers’ Comp

Once you turn in your claim form, the insurance company has 90 days to accept or deny your claim. If it doesn’t deny it within 90 days, the law presumes your injury is covered. After that, the insurance company can only overcome that presumption with evidence it couldn’t have found within the 90 days.

For certain public safety workers, like firefighters and police officers with some types of injuries, the deadline is even shorter: 75 days.

This is why the date you turned in your claim form matters. Keep a copy of your signed form and proof of when you gave it to your employer.

Understanding Your Workers’ Comp Denial Letter

If your claim is denied, the insurance company or claims administrator must tell you in writing. This letter is one of the most important papers in your case, because it tells you exactly what you need to prove. Read it slowly, and more than once.

What a California Denial Letter Should Include

The reason for the denial, in writing
What was denied. The whole claim, or only part of it
Your rights, including how to challenge the decision
Where to get free help, such as the state’s Information and Assistance officers

Is It a Denial or a Delay?

Not every letter is a denial. If the insurance company needs more time to investigate, it may send a delay letter instead. A delay letter should explain what information is still needed and when a decision will be made. Remember the 90-day rule: if the insurance company doesn’t deny your claim within 90 days of when you turned in your claim form, the law presumes it’s covered. Keep every delay letter, since the dates can matter.

Full Denial vs. Partial Denial

A full denial means the insurance company says your whole claim isn’t covered.
A partial denial means part of your claim was accepted and part was denied. For example, the insurance company may accept your back injury but deny your shoulder, or accept your claim but deny disability checks for certain weeks.

A partial denial is easy to miss. Read the letter closely to see which body parts and which benefits were accepted and which were denied.

Common Phrases in Denial Letters, and What They Mean

What the letter says	What it usually means
“Did not arise out of or occur in the course of employment” (sometimes “AOE/COE”)	They say your injury didn’t happen at work or wasn’t caused by your job.
“Insufficient medical evidence”	Your medical records don’t yet connect your injury to your job.
“Pre-existing condition”	They blame an old injury, not your job.
“Post-termination claim”	You filed after being fired or laid off, so special rules apply.
“Not an employee”	They say you’re an independent contractor.
“Failure to report timely”	They say you waited too long to report the injury.

A Treatment Denial Is Different

Sometimes the letter doesn’t deny your whole claim. It only denies a specific treatment your doctor asked for, like surgery, an MRI or more therapy. That’s called a utilization review decision, and it follows a different path. You have only 30 days to ask for Independent Medical Review. Learn more in the workers’ comp appeal process.

What to Do With Your Denial Letter

Keep the letter and the envelope. The postmark can matter, since deadlines often run from the date a letter was mailed.
Write down the date you got it.
Don’t throw away any other letters from the insurance company, even ones that seem routine.
Bring it to a lawyer. A vague letter, or one that doesn’t give a clear reason, can be important evidence in your case.

What to Do If Your Workers’ Comp Claim Is Denied

What you do in the first few weeks after a denial can make a big difference. Here’s what to do:

Don’t give up, and don’t wait. A denial can be challenged, but deadlines apply.
Read the denial letter and write down the reason the insurance company gave.
Keep every document, including the denial letter, your claim form (DWC-1), medical records, pay stubs and any emails or texts with your employer.
Keep getting medical care. A gap in treatment can make your case harder. If you have health insurance, you may be able to use it for now.
Write down what happened and the names of anyone who saw your accident or knew about your injury.
Don’t sign anything or give a recorded statement to the insurance company without talking to a lawyer.
Talk to a workers’ comp lawyer about your denial. Many denials are fixed with better medical evidence or by showing the insurance company got the facts wrong.

In most cases, you have one year from the date of your injury to file a case with the Workers’ Compensation Appeals Board. That deadline can be different if you’ve already received benefits, so don’t guess. When you’re ready to challenge the denial, see the full workers’ comp appeal process.

What Happens to Medical Bills If Workers’ Comp Is Denied?

This is one of the biggest worries after a denial. Here’s how it usually works:

While your claim was being decided, the insurance company had to pay for up to $10,000 in medical treatment. That treatment doesn’t have to be paid back just because the claim was later denied.
After a denial, you can use your own health insurance, if you have it, to keep getting care. If you later win your workers’ comp case, the workers’ comp insurance company can be required to pay for that care, and your health insurer may be paid back.
Doctors may agree to wait. Some doctors treat injured workers while a case is in dispute and get paid when it’s resolved, through what’s called a lien.

If you get bills for your work injury, don’t ignore them. Keep copies and bring them to your lawyer.

What About Lost Wages After a Denial?

If workers’ comp won’t pay your disability checks, you may be able to get State Disability Insurance (SDI) from California’s EDD while you fight the denial. If you later win your workers’ comp case, the EDD may be paid back from your workers’ comp benefits, so you don’t get paid twice for the same time off. Learn more about workers’ comp benefits.

How We Fight a Denied Workers’ Comp Claim

Every denial has a reason, and every reason has an answer. When you bring us your denial, we:

Find out exactly why you were denied and what the insurance company says is missing
Gather the evidence that fills the gap, like medical records, witness statements, time cards and your report of the injury
Get strong medical opinions. Many denials come down to what a doctor says. We work to get your injury evaluated by doctors who will look at the full picture, including neutral, state-certified evaluators when there’s a dispute.
Push back on “old injury” and “not at work” arguments with facts and medical evidence
Take your case before a workers’ comp judge if the insurance company won’t change its decision

Lawyers Who Know How Insurance Companies Think

Gary Rodich spent the early part of his career working for insurance companies before he switched sides to represent injured workers. He knows how adjusters build a denial, and how to take one apart. He has also served as a judge pro tem.

Gary Rodich is a Certified Specialist in Workers’ Compensation Law, certified by the State Bar of California Board of Legal Specialization. Learn more about our attorneys.

Results From Overturned Denials

Repetitive work injury, first denied: after the denial was overturned, the worker received multiple back surgeries and a $1,200,000 award with lifetime medical benefits.
Silicosis, work connection denied: the insurance company denied that the lung disease was work-related and refused a lung transplant. The case resolved with a $2,000,000 settlement.

See more case results and client testimonials. Past results don’t guarantee the outcome of a new claim. Every case depends on its own facts.

Workers' Compensation

Rodich Law focuses exclusively on workers' compensation, helping injured workers protect their rights and pursue the benefits they deserve. We represent workers across a wide range of industries and workplace injuries.

Denied Workers' Comp Claim | FAQs

What happens if my workers' comp claim is denied?

You can challenge it. A denial is the insurance company’s decision, not a judge’s, and in California a workers’ comp judge can overrule it.

Right after a denial, the insurance company usually stops paying for treatment and disability checks for the denied parts of your claim. In the meantime, you can often keep getting care through your own health insurance, and you may be able to get State Disability Insurance (SDI) from the EDD while you fight the denial.

From there, a denied claim usually moves forward in one of these ways:

The insurance company changes its mind. Sometimes new medical records, witness statements or proof you reported the injury on time are enough to reverse the denial.
A neutral doctor weighs in. If the denial is based on a medical question, like whether your job caused your injury, a state-certified doctor called a Qualified Medical Evaluator (QME) can examine you and write a report.
You open a case with the Workers’ Compensation Appeals Board (WCAB). Your case goes to a settlement conference, where many cases settle. If it doesn’t settle, a workers’ comp judge decides it at trial.

If the denial is overturned, you can get the benefits you should have been paid, including back pay for missed disability checks, and the insurance company may owe penalties for unreasonable delays. In most cases, you have one year from your injury to file with the WCAB, so don’t wait. See the full workers’ comp appeal process.

Why would workers' comp deny a claim?

In California, workers’ comp insurance companies most often deny claims because they say the injury wasn’t caused by work, there isn’t enough medical evidence, or the injury was reported too late. The most common reasons for a workers’ comp denial are:

Late reporting. The injury wasn’t reported to the employer within 30 days.
Not enough medical evidence. The medical records don’t clearly connect the injury to the job.
Not work-related. The insurance company says the injury happened off the clock, during a personal errand or while commuting.
A pre-existing condition. The insurance company blames an old injury or aging.
Gaps in treatment. Missed appointments or delays in seeing a doctor.
Not an employee. The worker is labeled an independent contractor.
Filed after being fired or laid off. California has special rules for these claims.

The insurance company must give the reason for the denial in writing, in your denial letter. Many of these reasons can be challenged with better medical evidence, witness statements or proof of when you reported the injury.

How long does workers' comp have to deny a claim in California?

In California, the workers’ comp insurance company has 90 days from the date you turn in your claim form (DWC-1) to accept or deny your claim. If it doesn’t deny the claim within 90 days, the law presumes your injury is covered, and the insurance company can only overcome that with evidence it couldn’t have found within the 90 days.

Shorter deadline for some public safety workers: for certain injuries to firefighters, police officers and other public safety workers, the deadline is 75 days.
Medical care during those 90 days: the insurance company must pay for up to $10,000 in treatment while it decides.
A delay is not a denial: if the insurance company needs more time, it should send a delay letter explaining why. The 90-day clock keeps running.

Tip: keep a copy of your signed claim form and proof of the date you gave it to your employer. That date starts the 90-day clock.

Can workers' comp deny a claim after accepting it?

They can deny or stop specific benefits, like certain treatment or disability checks, even after accepting a claim. Each of those decisions can be challenged too.

Can I see my own doctor if my workers' comp claim is denied?

Yes. If your claim is denied, you can get care through your own health insurance or doctor. If you later win, the workers' comp insurance company can be required to cover that care.

How hard is it to win a denied workers' comp case?

It depends mostly on the medical evidence and the reason for the denial. Late reports, short medical records and conflicting doctor opinions make cases harder. Strong medical evidence and witnesses make them easier.

Do I need a lawyer for a denied workers' comp claim?

The law doesn't require one. But once a claim is denied, you're in a legal dispute with an insurance company that has its own lawyers. A lawyer can gather the evidence, handle the forms and deadlines, and represent you before a judge. Learn how a workers' comp attorney can help you.

Can I sue my employer if workers' comp denies my claim?

Usually not. Workers' comp is normally your only claim against your employer, even after a denial. The way to fight a denial is through the workers' comp system. If your employer didn't have workers' comp insurance, different rules apply.

Can I be fired for fighting a workers' comp denial?

No. California law protects you from being fired or punished for filing or pursuing a workers' comp claim. If it happens, you may have a claim for wrongful termination.

Was my claim denied because of my immigration status?

It shouldn't be. California workers' comp covers injured workers no matter their immigration status, and your status can't be used to deny your benefits. Lea más en español.

Get a Free Review of Your Denied Claim

You deserve a second look at your claim, and the insurance company won’t give you one. Rodich Law can review your denial for free and tell you where you stand. We help injured workers across Southern California from our office in Woodland Hills. Call (818) 888-3000 or contact us online.

Learn more about the workers’ comp appeal process, workers’ comp benefits and your rights as an injured worker.