1. Understand Why Your Claim Was Denied
The first step in appealing a denial is to determine the reason behind it. You should receive a denial letter from the insurance company explaining why your claim was rejected. Some of the most common reasons include:
- Missed Deadlines: In California, you must report your injury to your employer within 30 days and file a workers’ compensation claim within one year. Failing to meet these deadlines can result in an automatic denial.
- Lack of Medical Evidence: If your medical records do not clearly link your injury to your job, the insurance company may claim that your condition is unrelated to work.
- Employer Disputes the Injury: Your employer may argue that your injury did not happen at work, was due to pre-existing conditions, or was not serious enough to qualify for benefits.
- Failure to Seek Medical Treatment: If you did not seek medical care right away, the insurer may argue that your injury was not severe or was caused by something outside of work.
- Administrative Errors: Simple mistakes, such as missing paperwork or incorrect claim forms, can result in a denial.
Understanding the reason for the denial will help you determine your next steps and build a stronger case for appeal.
2. Gather Evidence to Strengthen Your Case
If your claim was denied, you will need to provide additional evidence to support your case. Consider the following:
- Medical Records: Request a detailed medical report from your doctor, explaining how your injury is work-related. If necessary, seek a second opinion from another medical professional.
- Witness Statements: If coworkers saw the accident or injury occur, their statements can help support your claim.
- Workplace Incident Reports: If you reported your injury to a supervisor or HR department, request a copy of any incident reports or documentation.
- Employment Records: If your employer is disputing your claim, providing proof of your job duties and working conditions can strengthen your case.
Having solid documentation can make a significant difference in overturning a denied claim.
3. File an Appeal with the Workers’ Compensation Appeals Board (WCAB)
If your claim has been denied, you have the right to appeal the decision with the California Workers’ Compensation Appeals Board (WCAB). This process involves:
- Filing a Petition: You must submit a form called a Declaration of Readiness to Proceed (DOR) to request a hearing before a judge.
- Attending a Hearing: A workers’ compensation judge will review your case and may attempt to resolve it through settlement negotiations.
- Trial (if necessary): If no settlement is reached, your case may go to trial, where evidence and witness testimony will be presented.
Navigating the appeals process can be complicated, which is why it is beneficial to work with an experienced workers’ compensation attorney.
4. Consult a Workers’ Compensation Attorney
Workers’ compensation laws in California are complex, and fighting a denied claim can be overwhelming—especially while recovering from an injury. An experienced attorney can:
- Review your denial letter and identify the best strategy for appealing your claim.
- Gather additional medical evidence and expert opinions to support your case.
- Represent you in hearings before the Workers’ Compensation Appeals Board.
- Negotiate with insurance companies to secure the benefits you are entitled to.
At Kinsler Law, we understand the urgency and stress that comes with a denied claim. That is why we offer flexible legal consultations via Zoom and phone, so you can get the legal help you need without having to visit an office. Whether you need advice on filing an appeal or representation in a hearing, we are here to help.
5. Take Action Quickly – Deadlines Matter
The workers’ compensation appeals process is time-sensitive. If your claim has been denied, it is important to act quickly to protect your rights. Missing deadlines or failing to submit the proper paperwork can prevent you from receiving benefits.
If you have received a denial letter, do not wait—contact Kinsler Law today to schedule a free consultation. We will review your case, explain your options, and guide you through the next steps.
A denied workers’ compensation claim does not mean you are out of options. Many valid claims are initially denied due to technical errors, missing documentation, or disputes from employers or insurance companies. By appealing the decision and working with an experienced attorney, you can fight for the benefits you deserve.
At Kinsler Law, we are committed to protecting the rights of injured workers across California. If your claim has been denied, we can provide the guidance and representation you need—with flexible consultations available by Zoom and phone for your convenience.
Do not let a denial stop you from getting the compensation you need. Contact Kinsler Law today for a free consultation.