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Do I Have Any Options if My Workers' Comp Claim Was Denied?

If you have been injured while on the job, you are covered by an employer’s workers’ compensation insurance. However, workers’ comp claims may be denied for various reasons. If your worker’s compensation claim is denied, you will receive a letter which states the reasons your claim was denied.

Common reasons for denial of workers’ comp benefits include, but are not limited to, the following:

  1. Claim was not filed in time
  2. Injury was not reported on time
  3. You received no medical treatment after suffering the injury
  4. Insufficient evidence that injury is work-related
  5. Injury is not compensable
  6. Employer disputes claim

Appealing a Workers’ Comp Claim

Now that you know why your claim is denied, the first step is to contact your employer or its workers’ compensation insurance carrier to discuss your claim denial. If the denial was the result of mistaken paperwork or other similar issues, the error could be cleared up and your claim allowed. However, unless your claim denial was a significant mistake on the part of your employer or its insurance company, this route is likely unsuccessful.

If you wish to appeal the decision, you can request a hearing in front of a local Workers’ Compensation Appeals Board judge by filing an Application for Adjudication of Claim. Next, you will also need to file a form called a Declaration of Readiness to Proceed (DOR).

Priority Conference

If the insurance company has denied your claim due to the belief that your injury “arose out of employment” (AOE) or that the injury did not occur “in the course of your employment” (COE), the judge will schedule an expedited conference date so that these issues can be immediately resolved and your claim can be accepted or denied. Ensure that you check the boxes “Priority Conference” and “AOE/COE.”

Pre-Trial Conference

Once you submit the DOR form, a pre-trial conference may be scheduled—if your denial wasn’t based on AOE/COE issues. You should receive a notice of hearing, which sets a date, time, and location of the conference. At the conference, the judge will help you attempt to resolve the problem over whether the claim should be accepted or denied. If the dispute cannot reach a settlement, the judge will then set the matter for trial.

Get Help from an Experienced Attorney

If your workers’ comp claim was denied, your denial may be successfully appealed in many cases, but you will probably want to work with an experienced workers’ compensation lawyer. With more than 40 years of experience, our Sacramento workers’ comp attorneys at Smolich and Smolich have handled complex legal matters and understand what it takes to get the most favorable outcome possible.

Contact us and schedule a free consultation today.