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What should you do if your workers’ compensation claim is denied?

On Behalf of | Mar 19, 2021 | Workers' Compensation |

If you start a workers’ compensation claim after getting hurt on the job, you hope that you will get a quick approval and begin to receive the benefits that you need. Unfortunately, some people will have to deal with a denial.

Workers’ compensation claims can be denied for many reasons. Some of the most common reasons include:

  • Having an injury that is not compensable, such as one that isn’t related to your job
  • Not filing the claim in time
  • Not reporting the injury in time
  • Not seeking medical treatment
  • Not having enough evidence that the injury can be linked to your work
  • The employer disputing the claim

All of these issues can lead to a denial from the workers’ compensation insurance provider. If that happens, you may be frustrated, but there are steps you can take to appeal.

How do you appeal your workers’ compensation claim’s denial?

If your workers’ compensation claim is denied, then you need to file a case at one of the 24 Division of Workers’ Compensation offices around California. You can file this case with an Application for Adjudication of Claim, which is something your attorney can have you fill out if you intend to appeal. This application is then submitted to the DWC office, and then you have to serve it to other parties, like your claims administrator.

After this, the next step is to receive your case number. Once you have that, you can file a Declaration of Readiness to Proceed. This paperwork seeks a hearing. The hearing will be scheduled. You’ll receive a notice for a hearing named a mandatory settlement conference, or MSC, which is where you and the claims administrator (with your attorneys) will speak with a judge, discuss the case and attempt to reach a settlement. If you can’t reach a settlement, then the case could go to trial.

Your attorney can help you through the appeals process, so you can have the opportunity to overturn the denial. This may take some time, so it’s a good idea to appeal as soon as possible. Even if your case does go to trial, it could be months before you get the results.