Appealing a denied worker’s compensation claim in 5 steps

| Jul 27, 2020 | Worker's Compensation |

According to the U.S. Bureau of Labor Statistics (BLS), nearly 3 million people suffer work injuries every year. Worker’s compensation insurance, the liability coverage that employers carry, covers 93% of those claims.

So what are those 200,000 people denied coverage supposed to do? Many people will have already secured treatment, believing worker’s compensation would cover their injuries. For those folks whose medical bills are due, appealing remains an option.

California’s appeals process

Appealing a worker’s compensation denial is a multi-step process. Though the process may seem long, individuals have much more success with the right help. Those who object to their ruling can follow these five guidelines to appeal:

  1. Hire a lawyer: Those injured on the job find more success with appealing a worker’s comp denial alongside a local lawyer familiar with California’s worker compensation laws.
  2. File a case: A worker must then file an Application for Adjudication of Claim with the Division of Worker’s Compensation (DWC) office in the county where the injury occurred.
  3. File hearing declaration: The individual then files a Declaration of Readiness to Proceed. The court will schedule a hearing before a judge.
  4. Decide to settle or go to court: At the hearing, the judge will listen to arguments of the injured party and the claims adjuster. The adjuster will likely offer a settlement. Legal counsel can help a person decide to settle or go to court. The claimant will need documents that outline the dispute, evidence and witnesses to testify.
  5. Trial defense: Another judge will attend the trial. The judge will send their decision between 30 and 90 days after the trial.

If the judge upholds the denial, the claimant can petition the courts for reconsideration. An attorney can help assess the likelihood of success and help with the next steps.

Fight for the coverage workers deserve

Studies have shown that nearly 70% of denied claims convert to paid claims eventually. With the right help, those filing appeals stand a good chance of securing the coverage they need.