To appeal a denied workers’ compensation claim in California, you must file additional forms to request reconsiderations, hearings, and final reviews. Depending on the strength of your claim, you may only need to file a single reconsideration request to get a positive outcome in your case. Other claims are more complex and take multiple reconsider requests and hearings to reach an end.
Here are the steps you can take to file a case for your denied workers’ compensation claim in California:
Find a Workers’ Compensation Lawyer
A workers’ compensation lawyer Los Angeles can help you navigate the complex process of appealing a denial. First, they can help you stay on top of deadlines as you must file certain paperwork within just a few short weeks.
Your lawyer can also update you on the status of your claim at each stage of the appeal so you can focus on recovery and only take action when necessary. They can also represent you in hearings, prepare you for trial, and fight for the compensation you deserve.
Determine Why Your Claim Was Denied
When you know why your claim was denied, you and your legal team can find ways to correct it if possible. Some of the most common reasons workers’ compensation claims are denied in California include:
- Failing to report your injury within 30 days of becoming injured at work or discovering a work-related injury or illness
- Your employer believing that your injury did not arise from work or occur during work
- Failing to file a workers’ compensation claim within the one-year filing deadline
- Failing to receive medical diagnosis or treatment from an approved medical provider
Some of these may be appealed with corrections and additional evidence to prove you deserve compensation. Other reasons for being denied workers’ compensation benefits may disqualify you from appealing. A workers’ compensation lawyer can review your case and determine whether your denial can be appealed.
Fill Out the Application for Adjudication of Claim
Your first step in appealing the denial is to fill out an application for adjudication of claim form. On this form, you and your lawyer can include information like:
- Your workers’ compensation case number
- Your personal information
- Your employer’s information
- The claims adjuster’s information, if available
- Information about your work-related injuries or illnesses and their link to your work
- The prognosis and treatment for the injuries or illnesses
- Where and from whom you received treatment or assessment
- Your legal representative’s information
Submit the Application for Adjudication of Claim at Your County DWC Office
You must file the application for adjudication of claim form at your county’s Division of Workers’ Compensation (DWC) office. This form will go directly to a judge from the DWC’s appeals board for an initial review. You must also provide a completed copy of the form to the claims adjuster.
Receive an Application Receipt Notice
The appeals board will notify you when they receive the form. Then they’ll provide you a case number starting with “ADJ” (for adjudication) so you and your legal team can track the status of your appeal and take further action on it.
Request a Hearing
Submitting the application for adjudication of claim form does not guarantee a hearing. If you would like to appeal your case, you must file a Declaration of Readiness to Proceed. This form includes information like:
- The type of hearing you want: You would select a “mandatory settlement conference (MSC)” in this case.
- What issues you have with your claim: This can include disability payments, compensation amount, or access to covered medical treatment in the future.
Attend an Appeals Hearing
At the MSC, an appeals judge will hear your side and the claims adjuster’s side. Then, they’ll mediate a solution and try to help both parties come to a settlement agreement. Your lawyer can handle all negotiations and argumentation at the hearing.
Take the Case to Trial
If the MSC does not provide the result that you or the claims adjuster agree to, your claim may go to trial. You and your legal team can outline your argument for why you need the result you’re looking for, such as more compensation for lost income or medical costs. Between 30 and 90 days after the trial, the judge will send a written decision on whether you’ll receive the adjusted accommodations or compensation you requested.You or the claims adjuster may take steps to appeal this decision.
Complete a Petition for Reconsideration of Your Claim
Your next step is to file a petition for reconsideration, which goes directly to the DWC appeals board. They will have 60 days to accept or deny formal reconsideration based on the argument you present in the filing. If you don’t receive a response within 60 days, your request for reconsideration is denied. If your reconsideration is accepted, your legal team can further argue for your right to compensation.
File a Writ of Review
If your petition for reconsideration is denied, your final step to appeal your denial is to file for a writ of review within 45 days. This sends your case to the appellate court, which will determine if the appeals board was correct in its decision or if it must reconsider.
KJT Law Group Can Help File a Case for Your Denied Workers’ Compensation Claim
If you or a loved one are facing a denied workers’ compensation claim in California, the team at KJT Law Group wants to help you get the benefits you deserve. We can handle the appeals process from beginning to end, even if we didn’t help you with your initial claim. We can guide you through filling out paperwork, gathering evidence, correcting incomplete and inaccurate claim information, and presenting your need for compensation to the board.Call our office at (818) 507-8525 to schedule a free consultation and learn more about how we can help with your workers’ compensation appeal.