After being hurt on the job, many California employees file claims to have their medical and other costs paid for -- just as they were told to do. They begin to receive medical treatment and take time off work to recover only to find out that their claims for workplace injuries were denied. Panic sets in since medical care is expensive, and they wonder about running out of sick time. Fortunately, there is an appeals process for denied claims.
Any worker who receives a denial of his or her workers' compensation claim needs to act quickly. There is a deadline for challenging the claim administrator's decision. After filing an Application for Adjudication of Claim with the appropriate office, a worker receives a notification that the claim was received. Thereafter, a Declaration of Readiness to Proceed must be filed in order to schedule a mandatory settlement conference with an administrative law judge.
As part of this process, the injured worker may undergo an independent medical review. A qualified medical evaluator handles this review. A worker may be able to participate in choosing of this evaluator if represented by counsel. If the matter is not settled at the mandatory settlement conference, the matter may then go to trial before a different judge. Finally, if a worker's claim is still denied, a Petition for Reconsideration may be filed.
An error at any point could result in the worker being responsible for medical bills and other costs that should rightfully be paid for through the workers' compensation system. A worker should have the freedom to focus on his or her recovery without the added stress of wondering how to pay for medical care and the monthly bills. Considering what is at stake, California employees who are denied benefits after workplace injuries may want to consider having an attorney to advise and represent them through this process.
Source: dir.ca.gov, "If my claim was denied", Accessed on June 2, 2017