How to Appeal Your Workers’ Compensation Claim Denial

Denied workers' compensation in San Diego.

When you go through the process of seeking workers’ compensation for a work-related injury or illness, your claim may be denied for a number of reasons. Getting that letter in the mail from your claims administrator can be frustrating, but it doesn’t mean you should give up fighting for your rights and the benefits you deserve. 

At the Law Office of Gerald D. Brody & Associates, we’ve helped countless injured employees appeal their workers’ compensation claim denials. Whether you didn’t file your claim on time, your injury wasn’t considered severe enough, or your employer is disputing that the accident was work-related, we’ve seen it all. 

Why was my workers’ compensation claim denied?

Many employers actively look for reasons to deny an injured worker’s claim. After all, when a company accepts liability for a work-related accident, its insurance premium goes up. If your employer disputes your claim, you will need to gather evidence to support your case. Witness accounts that the injury actually happened at work and a statement from your doctor attributing your condition to your job are good places to start.

Another reason your workers’ compensation claim may have been denied was that you failed to report the claim in a timely manner. In California, the deadline to notify your employer of a workplace accident is five days. Once you receive your workers’ compensation claim denial letter and determine the reason your claim was denied, the next step is to file an appeal.

How do I appeal my workers’ compensation claim denial in San Diego?

The first step in appealing your claim denial is filing an “Application for Adjustment of Claim.” You may file the application on your own or under the guidance of an attorney. Next, you will need to request a hearing before your local Workers’ Comp Appeals Board judge. But, before you can do this, you or your lawyer will need to file a form called a “Declaration of Readiness to Proceed.”

Once you submit the Declaration of Readiness to Proceed form, you may receive a notice of hearing for a pre-trial conference. At the conference, the judge will attempt to resolve the issue of whether your workers’ compensation claim should be accepted or denied. If the case is left unsettled, the judge will then schedule a date for trial. 

Generally, disputes that make it to a pre-trial conference are settled and accepted by the insurance company at that time. However, if a trial is necessary, your attendance is mandatory. The judge will issue a written decision after the trial and send it to you by mail within 30 to 90 days.

Do I need an attorney to appeal my workers' compensation claim denial?

If your workers’ compensation claim was denied, the professional attorneys at the Law Office of Gerald D. Brody & Associates can help you make sense of the complicated workers’ compensation system and guide you through the appeals process. Call our office today to schedule your free initial consultation. We’re happy to lend our time to help you collect the benefits you deserve. Give us a call at (619) 528-9800.