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How to Appeal a Denied Workers’ Comp Claim in CA

How to Appeal Denied Workers’ Compensation in California

If you were denied workers’ compensation after sustaining a workplace injury in California, it’s important not to lose hope. With the support of an experienced workers’ compensation attorney, it’s possible to appeal and reverse this decision.

However, time is of the essence after a claim is denied. If you’re an injured California employee hoping to appeal a denied workers’ comp claim, it’s wise to seek strong legal representation from a workers’ compensation attorney as soon as possible. A qualified lawyer can help gather evidence to strengthen your case and protect your rights against larger insurance firms that may attempt to take advantage of you in court.

Why Was My Workers’ Comp Claim Denied?

Many workers know how invalidating it feels to be denied workers’ comp benefits that you’re entitled to. It can be frustrating to hear that your pain and suffering, not to mention accrued medical costs and loss of wages, were essentially dismissed by those with the power to help you.

Fortunately, there are ways to appeal the decision and with the help of a skilled legal advocate, you may be able to recover the compensation you deserve. First, it’s necessary to understand why your workers’ comp claim was denied. There are numerous reasons why a request for workers’ compensation may be rejected, such as:

  • The employee failed to meet filing deadlines. California employees must report a workplace injury to their employer within 30 days in order to be eligible for workers' compensation benefits. Failing to meet this time limit could result in the denial of your claim.
  • The employee has a preexisting medical condition. According to the California Department of Industrial Relations, if an employee's preexisting medical condition is aggravated or accelerated due to a work-related injury, they may be entitled to workers' compensation benefits. However, if the employee's preexisting medical condition is not aggravated or accelerated by their work-related injury, then they may not be eligible. Keep in mind that a preexisting medical condition should never be an automatic disqualifier for workers’ compensation.
  • There isn’t sufficient evidence to support the injury or incident. It's critical to back your claims with strong evidence when filing for workers' compensation, otherwise the employee may risk getting denied. A knowledgeable attorney can help you collect and use relevant evidence to fortify your case in court and recover the compensation you deserve.

As unfair as it can feel to be wrongfully denied, rest assured that there are ways to appeal the decision. Keep reading to learn what steps injured workers can take to appeal workers’ comp claims in California.

How to Appeal a Denied Workers’ Comp Claim

Appealing a workers’ comp claim can be complex. It’s crucial for injured employees to follow legal processes meticulously, as even a small misstep can result in another rejection. If you are a California employee hoping to appeal your case, you may be wondering what steps to take next.

In addition to seeking trusted counsel from an experienced attorney, workers may take the following steps to appeal a denied workers’ comp claim in California:

1. File the correct petition.

Generally, injured employees who are denied workers’ comp benefits are permitted to appeal the decision under California law if:

  • There is new evidence;
  • If the evidence doesn't support the decision;
  • If there was fraudulent activity involved; and/or
  • If the decision will cause great harm.

In California, there are two ways to appeal a denied workers' comp claim:

  1. Petition for Reconsideration. An employee may file this appeal with the Workers’ Compensation Appeals Board (WCAB) to request a review of the decision made by the claims administrator or insurance carrier. This petition must be filed within one year of the date of denial. The WCAB will then review all evidence presented and make a decision based on that evidence.
  2. Petition for Removal. A worker may file this appeal with WCAB to request that the case be removed from the jurisdiction of the claims administrator or insurance carrier and instead heard by an administrative law judge (ALJ). This petition must be filed within 20 days of receipt of notice of denial. The ALJ will then review all evidence presented and make a decision based on that evidence.

It's important to act quickly, as there are strict deadlines associated with both petitions for reconsideration and removal in California. It’s important to consult with your lawyer to determine which petition is most appropriate for your unique circumstances, as filing the wrong petition can result in the swift dismissal of your case.

2. Attend the hearing.

After filing, employees will appear before a judge from the Workers’ Compensation Appeals Board. During the hearing, the judge will hear from both parties as they present evidence and testimony to support their claims.

3. Wait to receive the decision.

After your hearing, the Workers’ Compensation Board will decide to deny or grant your request. Should your appeal be denied, you may then file a Writ of Review with the California Court of Appeals. Here, you can ask for a second review of your case to see if the denial was unjustified or reached without sufficient evidence.

Over Half a Billion Recovered for Injured Workers in CA

When it comes to asserting your rights after a workplace injury, you can count on Alvandi Law Group to fight for the compensation you deserve. Our skilled attorneys have an in-depth knowledge of the law and are 100% dedicated to workers’ compensation cases, giving us a considerable edge in the courtroom.

Our firm has successfully recovered over a billion dollars on behalf of injured workers throughout California, making our powerhouse legal advocates well-equipped to assist with a range of workers’ compensation disputes. If you were wrongfully denied workers’ compensation benefits after a workplace accident, turn to a legal team you can trust to prioritize your best interests.

Our workers’ comp attorneys can help fight for the maximum compensation you deserve. Call (800) 980-6905 to schedule a free consultation.


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