Workers' Comp Claim Denied in California? We Can Help

Denied Workers’ Compensation Claim? We Can Help.

Was your workers’ compensation claim denied? Don’t lose hope! The Hinden & Breslavsky, can help you explore your legal options and determine if you are eligible to appeal the claims administrator’s denial. If so, our Los Angeles workers’ compensation lawyers can help you take the necessary steps to file your appeal and seek the full, fair benefits you are owed.

Appealing A Denied Workers’ Comp Claim In California

If your workers’ compensation claim was officially denied (as opposed to refused by your employer), it means that the claims adjuster who handled your claim determined that your injury/illness was not covered by workers’ comp insurance. However, remember: An insurance adjusters’ primary goal is to limit the amount they have to pay out. They are not on your side. Just because your claim was denied does not mean that you are not eligible for workers’ compensation benefits.

California law allows you to challenge a workers’ compensation claim denial. You will need to follow a certain process to do so, and our Los Angeles workers’ comp attorneys can help.

In order to appeal your claim denial, you will need to do the following:

First, you will need to file an Application for Adjudication of Claim with the DWC office in your county of residence (or the county in which your injuries/illness occurred).
Next, you will receive confirmation from the DWC office that your application has been received, as well as an assigned case number. Keep these documents.
If you wish to request a hearing before a judge, you will need to file a Declaration of Readiness to Proceed. You will then be scheduled for a Mandatory Settlement Conference hearing.
At the hearing, both you and the claims administrator (and/or your attorneys) will need to be present. The purpose of the MSC hearing is to reach a settlement agreement.
If a settlement agreement cannot be reached at the MSC hearing, the judge will schedule a date for your trial, which will go before another judge.
After the trial, the judge will send you his/her decision regarding your case by mail, typically within 30 to 90 days.
If you wish to object to the judge’s decision, you may file a Petition for Reconsideration, which will prompt a review of the decision.

At each stage of this process, you will be required to complete and submit various documents and applications, and you may need to gather and prepare evidence, including medical records. Our attorneys can assist you with everything involved in appealing your denied workers’ compensation claim.

What If You Disagree With Your Doctor’s Assessment Of Your Injuries?

Often, workers’ compensation claim denials are triggered by the treating physician’s assessment of the injured worker’s injuries/illness. If you disagree with your doctor’s reports regarding your injuries or condition, you can choose to be seen by a Qualified Medical Evaluator (QME). QMEs are physicians who have met certain requirements, including additional education and licensing, and who have passed a workers’ compensation evaluation process test.

QMEs are also required to attend ongoing training and education in the area of workers’ compensation. If you disagree with your doctor’s assessment of your injuries, our workers’ compensation lawyers can help you resolve the dispute through the use of a QME or AME (Agreed Medical Evaluator). We can also help you navigate the independent medical review process.