Denied Workers’ Comp? How to Appeal in California
If you’re a construction worker in California and your workers’ compensation claim has been denied, don’t panic. Many workers go through the same situation. Fortunately, California law provides a clear process for appealing denied claims. You still have a chance to get the medical care and financial help you need. Here’s a simple step-by-step guide to help you understand your options.
Why Was Your Workers’ Comp Claim Denied?
Before starting your appeal, find out why your claim was denied. Common reasons include:
- The employer disagrees the injury happened at work.
- The injury wasn’t reported on time.
- The claim was filed too late.
- The injury is not covered by workers’ comp law.
- No medical evidence supports the injury.
Understanding the reason gives you a clear path to fight back and correct any issues in the appeal process.
Step 1: File an Application for Adjudication of Claim
If you’ve received a denial letter, your first step is to file an “Application for Adjudication of Claim” with the California Workers’ Compensation Appeals Board (WCAB). This step officially starts your appeal process. You must file this application within one year from the date of injury or from when you last received any benefits. Make sure to keep copies of all documents.
Step 2: Request a Hearing – Declaration of Readiness to Proceed
After filing the application, you’ll need to ask for a hearing by submitting a “Declaration of Readiness to Proceed.” This tells the WCAB that you’re ready to go before a judge. The court will schedule a conference called a Mandatory Settlement Conference (MSC).
Step 3: Attend the Conference
During the MSC, your case may be resolved through settlement discussions. If you and the insurance company can’t reach an agreement, the case will move forward to a trial, where a workers’ comp judge will review evidence and make a decision.
Step 4: The Trial
A judge will listen to both sides at trial. You’ll need to present evidence like medical records, witness statements, or other documents that support your claim. After the hearing, the judge will make a decision in writing, known as a “Findings and Award.”
Step 5: Appeal the Judge’s Decision (If Needed)
If the judge denies your claim again, you can file a Petition for Reconsideration within 20 days. This petition asks the WCAB to review the judge’s decision. Be sure to explain exactly why you believe the decision was wrong and include any new evidence if available.
Need Help with a Denied Workers’ Comp Claim?
Appealing a denied workers’ compensation claim can be stressful, especially if you’re recovering from an injury and dealing with job loss. It’s even more challenging for construction workers who may face serious injuries. If you’re struggling, you don’t have to do it alone.
Call Jonny Law at 800-566-4868 for expert help. Jonny Law understands California workers’ compensation law, especially for injured construction workers. Let your rights be protected so you can focus on healing.