What Is the Workers’ Compensation Appeals and Adjudication Process?

 workers' compensation appeals and adjudication process.

Getting hurt on the job can be traumatic, both physically and emotionally. Depending on the severity of your injury, you may be looking at time off work, surgery, and even permanent disability. During this difficult time, it’s comforting to know that you are protected from the financial consequences of recovery under workers’ compensation. Eligible employees receive payment for a portion of their missed wages, medical expenses, and retraining for a new job if necessary.

Unfortunately, it’s not always easy to claim the benefits you deserve. At the Law Office of Gerald Brody & Associates, we work with dozens of injured people every day who have had their workers’ compensation claims denied for a myriad of reasons. Sometimes an employee missed the deadline for filing, while other times the insurance company just doesn’t want to pay out for a claim and looks for a reason to deny it. The good news is that just because you receive a workers’ comp denial doesn’t necessarily mean you won’t get benefits – you may just need to take a few extra steps to get there.

Here’s an overview of the workers’ compensation appeals and adjudication process:

Workers’ compensation appeals and adjudication process

Your employer’s insurance company has 90 days from when you filed for workers’ compensation to accept or deny your claim. If you receive a notice of denial, you have a year from the date of your injury to file an appeal and pursue your right to collect benefits. Although you have this time, it’s in your best interest to take action immediately.

The first step towards appealing your workers’ comp denial is to file an Application for Adjudication of Claim with your local Workers’ Compensation Appeals Board (WCAB) office. This agency oversees the entire California workers’ compensation system and resolves disputes between injured workers and insurance companies.

Once the WCAB receives your Application for Adjudication of Claim, they’ll assign it a case number. From this point forward, the agency will officially retain the power to resolve issues and disputes related to your claim. To move the process along, you will need to request a hearing by filing a Declaration of Readiness to Proceed.

Before you go to trial, you will have the opportunity to settle your workers' comp denial in an informal meeting with your employer’s insurance company. The judge will be present to mediate the conference, but he or she will not make a decision regarding the dispute. A majority of workers with denied claims resolve their cases through settlement talks and never make it to their hearing.  

If you and your employer’s insurance company aren’t able to agree, your case will go to trial. At your hearing, you will appear before a judge where you’ll present your case and evidence, including medical records and witness testimonies. The insurance company will also be there, represented by an attorney, to make its argument against your claim. The judge will review the evidence and mail you a decision as to whether your claim should be accepted within 30 to 90 days.

For most workers, the idea of defending oneself before a judge is very intimidating. Fortunately, you don’t have to do it alone. A workers’ compensation attorney knows the local courts inside and out and can represent your best interests throughout the entire appeals and adjudication process.

Need help filing for adjudication in California? Call an experienced San Diego workers’ comp attorney.

When you’re recovering from a work-related injury, the last thing you need is a letter in the mail stating that you’ve been denied the benefits you desperately need. If you’re planning to file an appeal in the workers’ compensation system, an experienced attorney can take on the heavy lifting so you can focus on what’s most important – your health. At the Law Office of Gerald Brody & Associates, we have decades of experience negotiating with insurance companies and fighting hard on behalf of our clients. Call us today at (619) 528-9800 to see what we can do for you. Your initial consultation is free!