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Navigating a California workers’ compensation denial

man with frustration looking at letter

When an injured worker in California receives a denial of their workers’ compensation claim, it can feel like a door has closed. However, a denial is not the final word.

Workers’ compensation insurance provides critical support for employees who suffer work-related injuries. But what happens when this support seems unreachable due to a denied claim? California has a process for such situations.

Appealing a workers’ compensation denial in California

In California, if you receive a denial for a workers’ compensation claim, you can appeal this decision. You begin this process by filing an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board.

Filing an application for adjudication of claim

To initiate the appeal process, you must complete and file the Application for Adjudication of Claim. The application must include details about the workplace injury, the date, time, location of the injury and the resulting disability or impairment. You must submit this application to the WCAB office in the district where the injury occurred.

Declaration of readiness to proceed

Following the filing of an Application for Adjudication of Claim, you need to submit a form known as a Declaration of Readiness to Proceed. The DOR informs the WCAB that you can move forward with your case. Once the WCAB receives the DOR, they can schedule a mandatory settlement conference.

Mandatory settlement conference

The mandatory settlement conference offers an opportunity for you and the insurance company to negotiate a settlement. If negotiations for the settlement fail, the case moves to trial before a workers’ compensation judge.

Trial and potential further appeals

At the trial, both parties present their case to the judge, who then issues a decision. If either party disagrees with the judge’s decision, they can file a Petition for Reconsideration, leading to a review by the WCAB.

While receiving a denial for a workers’ compensation claim can be disheartening, it is not the end. By understanding the appeals process in California, workers can continue to seek the compensation they deserve following a work-related injury.