If you suffer an injury at work, you need workers’ compensation to help pay medical bills and basic living costs. However, a claims administrator might deny your claim, leaving you without the means to support yourself.
In the event of a denial, you can challenge the decision. According to the State of California Department of Industrial Relations, your contested denial goes to a workers’ compensation administrative law judge who reviews your case.
Disputes over your injury
A common reason for compensation denial is a dispute about the nature of your injury. Unfortunately, claims administrators sometimes disagree with your physician about your treatment or injury. If this happens, your employer might say your injury does not qualify for workers’ compensation. When this happens, a qualified medical evaluator examines your injury and gives a second opinion on workers’ compensation eligibility. Your attorney and claims administrator might negotiate on who the doctor will be.
Fighting your denied claim
Fighting the denial of your claim requires you to file a case at your local Division of Workers Compensation (DWC) office, called an Application for Adjudication of Claim. To qualify, you must file in the county where you received the injury or where you live. Once the office receives your application, they will notify you and assign a case number.
After you receive a case number, your next step is to file a Declaration of Readiness to Proceed. Finally, the DWC office will schedule your hearing.
As you can see, fighting a rejected workers’ compensation claim might take some time. Ensure you begin the filing process immediately, so you do not have to wait longer than necessary to receive your benefits.