Understanding the Workers' Comp Appeals Process

Providing Expert Guidance for Workers Whose Claims Have Been Denied

Filing a workers’ compensation claim can already be a lengthy and stressful process. Going through the trouble of filing the required paperwork and following the necessary procedures can then feel distressingly worthless if your workers’ comp claim is denied. Luckily, a denial isn’t the end of the process—you still have the option of appealing your claim. By teaming up with an attorney to work on your appeal, you can count on the process being done as accurately and efficiently as possible, setting you up for approval the second time around. At the Law Office of Ronald Ehrman, our Los Angeles work injury lawyer can guide you through the appeals process and represent you in a hearing if necessary. We will stand by your side the whole through because we believe injured employees deserve the benefits they are legally entitled to so they can make a strong recovery.

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What to Do If Your Workers' Comp Claim is Denied

If your workers’ comp claim was denied, your mind may be reeling as you wonder what the reasoning could be. A claim can be denied for myriad reasons, from not filling out the paperwork correctly to outright hostility from your employer and/or their insurance company.

Common workers’ compensation denial reasons include:

  • Claims paperwork was submitted after the statute of limitations (one year) expired
  • Whether or not the injury was work-related is in question
  • State guidelines were not met
  • The claim was filed after you left the job and started working for another company
  • You did not require medical treatment to recover from your injury
  • You did not require time off work to recover from your injury
  • Your employer’s insurance company routinely denies workers' comp claims

As you can see, some of the above are legitimate reasons to deny a claim; others are not. Whether or not your claim was rejected due to a viable reason or wrongdoing, there are steps you can take to continue fighting for youth benefits. So, what to do if your workers’ comp claim is denied? This is where the appeals process comes in.

What is the Workers' Comp Appeals Process?

If your workers’ compensation claim is rejected by your employer’s insurance company, it is vital to take steps to reverse their decision as quickly as possible. But, how to appeal a workers’ comp claim that was denied?

The workers’ comp appeals process in California involves attending a hearing before your local Workers' Compensation Appeals Board (WCAB) judge. During your hearing, the judge will hear from both sides before making their decision. If the dispute can't be settled at the hearing, the judge will set the matter for trial. Most disputes are settled at the pre-trial conference, however. If you do make it to trial, the judge will likely rule in your favor.

To request a hearing, you (or your attorney) must submit two forms:

  • Declaration of Readiness to Proceed (DOR) and
  • Application for Adjudication of Claim

This is your chance to state your case directly to a judge, but you don’t have to do it alone. Appeals are complicated, involving legalese and procedures that the judge will expect you to know and follow correctly. Many people lose their appeal because they didn’t have an experienced California workers’ compensation attorney help them prepare a strong case. To ensure the success of your appeal in the Los Angeles area, contact a work injury lawyer as soon as your claim is denied. The sooner you can start putting your appeal together, the better.

Appeal Process FAQ

Q. How long do workers’ comp appeals take?

A. Depending on how quickly you manage to submit the necessary paperwork and hire an attorney, the process usually doesn’t take long—the timelines for workers’ comp appeals tend to be short and strict.

If you end up going to trial, the verdict will be sent to you by mail between 30 and 90 days after the trial.

Q. How many times can you appeal a workers’ comp denial?

A. If your initial appeal doesn’t end the way you wanted it to following your hearing and trial, you can appeal to the California Worker’s Comp Appeals Board (WCAB) in San Francisco. You have 20 days from the date you received the decision from your district office to appeal it.

Q. What if my claim is STILL denied?

A. If you end up going to the appellate court in San Francisco and still don’t get the case result you’d hoped for, you then have the right to appeal your case to the California Supreme Court. However, the state supreme court rarely hears workers’ comp appeal cases.

Have more questions? To learn more about appealing a workers’ compensation claim in California, call us today at (213) 455-5808 or contact us online.

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Why Hire the Law Office of Ronald P. Ehrman?
  • No Recovery, No Fee

    Clients who turn to our firm pay us nothing unless we win a settlement on their behalf.

  • We Come to You.

    Whether you are bedridden at home or in the hospital, we accommodate your needs.

  • 24-Hour Availability

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