Over 40 Years Of Experience In Workers’ Compensation

What happens if my workers’ comp benefits are denied?

On Behalf of | Feb 1, 2022 | Filing/Appealing A Claim

Some California workers who file for workers’ compensation benefits wind up getting their legitimate claims denied. But that doesn’t mean they are out of options.

Read on to learn more about the process of appealing a workers’ comp denial.

Filing an application for adjudication of claim

The first step in appealing a decision on your workers’ compensation case is to file an application for adjudication of claim. Until this is done, no appeal can proceed. Once this has been done, the local Workers’ Compensation Appeals Board (WCAB) will assign a number to your case.

Filing a declaration of readiness to proceed

The declaration of readiness to proceed (DOR) is the next step. You must seek a conference with the WCAB. In it, you must detail your attempts to resolve any issues affecting your worker’s comp claim.

Request a WCAB hearing

You will now need to request a hearing with the WCAB to explain why the denial of benefits was incorrect and the reasons to reconsider the merits of your workers’ compensation claim. If this decision also goes against you, you still have options.

Petition the Higher California Workers’ Compensation Appeals Board 

Act quickly, because depending on the circumstances of the adjudication of the claim, you only have 20 or 25 days to file your petition. In it, you must show why the appeal decision was incorrect. After roughly two months, you will get their verdict mailed to you. Even now, you still have ways to overturn a denial.

File an appeal to the state appellate court

California claimants have 45 days in which to request a writ of review of the appellate court’s denial. While this court does not determine benefits, they can return your case for reconsideration by the WCAB.

Your final option

While exceedingly rare, there is one final step you can take to get a favorable decision in your workers’ comp case — petition the California Supreme Court to review your case on appeal. This court seldom hears worker’s compensation cases, so it is far better to present solid evidence why you should prevail at an earlier juncture.