De Ita, Lowe & Wald, LLP

Phone: 650-918-4999

What are my options when my workers' comp claim is denied?

Though workers' compensation is meant to be a no-fault compensation system for injured workers, the workers' compensation board can and often does deny claims. If the administration sent you a denial notice, it is because it believes that workers' compensation does not cover your injury. If you received a denial, you are not without options. You can contest the board's decision by filing a claim at one of the 24 Division of Workers' Compensation offices throughout California.

The Department of Industrial Relations details the three-step process necessary to object a claim denial. First, you must submit an Application for Adjudication of Claim with the DWC. You must file your application in the county in which you live or where you were injured. You must also serve notice to all other involved parties. Shortly after you file your claim, the DWC will send you a case number, which will begin with the letters ADJ.  

Once you receive your case number, and once you adequately prepare, schedule your hearing. You can do this by filing a Declaration of Readiness to Proceed. The DWC will schedule you for a hearing called a mandatory settlement conference.

On the day of your MSC, you will present your case before a judge, as will the claims adjuster. The judge will facilitate negotiations and attempt to help you and the adjuster reach an agreement. If you cannot reach an agreement during the allotted time, the judge will schedule a trial date.

If your case goes to trial, you will have the opportunity to present your evidence to another judge. The judge will not inform you for the verdict in person. Instead, you will receive written notice of his or her decision via mail within 30 to 90 days.

As with the administration's initial determination, the judge's verdict is not final. If either you or the claims adjuster is dissatisfied with the decision, you can file a Petition for Reconsideration.

The information in this article is intended to be for information purposes only. It should not be construed as legal advice. 

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De Ita, Lowe & Wald, LLP

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Phone: 650-918-4999
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