If your employer denies your workers’ compensation claim in California, it can feel overwhelming. You were hurt on the job, and now, your boss is denying you the benefits you need to get back to work. Do not fret. You have several options to challenge the denial.
First, review the denial letter
The first thing you should do is carefully examine the denial letter provided by your employer or their insurance company. This letter should clearly explain the reasons behind the denial. Understanding these reasons will help you identify the issues that need to be addressed, if you decide to appeal the decision.
File an Application for Adjudication of Claim
To challenge the denial, you must file an Application for Adjudication of Claim with the California Division of Workers’ Compensation. This application is a formal request for your case to be reviewed and must be submitted to the DWC office in the county where you live or where the injury occurred.
Request a hearing
Once your application is filed, you will receive a case number. The next step is to file a Declaration of Readiness to Proceed, which requests a hearing before a workers’ compensation administrative law judge. This hearing is a critical opportunity to present your case and argue why your workers’ compensation claim should be approved.
Gather supporting evidence
Before the hearing, it is essential to collect all necessary evidence to support your claim. This includes medical records, photographs, witness statements and any other documentation that can demonstrate that your injury is work-related and that you are entitled to compensation for your work-related injury. The more robust your evidence, the stronger your workers’ compensation case will be.
Attend the hearing
During the workers’ compensation hearing, you will present your evidence to the WCJ. Be prepared to clearly explain why the initial denial was incorrect and to provide your supporting documents and evidence. The judge will consider your supporting documents, all the presented evidence and make a decision regarding your workers’ compensation claim.
Consider a Qualified Medical Evaluator
If there is a dispute over the medical aspects of your injury, you may need to be evaluated by a Qualified Medical Evaluator. A QME is an independent doctor who provides an unbiased assessment of your injury, which can be pivotal in resolving the dispute.
An appeal of this judge may be necessary too
If the judge denies your workers’ compensation claim at the hearing, you still have the option to appeal the decision to the Workers’ Compensation Appeals Board. The WCAB will review the case and the evidence to determine whether the judge’s decision was appropriate.