Filing for workers’ compensation can already be a stressful process. When your claim is denied—especially after a serious injury—it’s easy to feel discouraged or overwhelmed. But here’s the truth: workers’ comp claim denials are common, and a denial doesn’t mean the end of the road. In California, you have the right to appeal the decision and fight for the benefits you deserve.
This guide will walk you through:
- The most common reasons claims are denied
- What steps to take after receiving a denial
- How to strengthen your appeal
- When and why to involve a workers’ comp attorney
If your claim has been denied, don’t panic—you have options.
Common Reasons Workers’ Comp Claims Are Denied in California
Understanding why your claim was denied is the first step toward fixing the problem. Some reasons are simple paperwork issues, while others may be disputed facts or questions about the legitimacy of your injury.
Here are some of the most frequent denial reasons in California:
Missed Deadline
California requires that you notify your employer of your injury within 30 days of the incident (or the date you became aware of the injury). If you didn’t report it on time, your claim could be denied outright.
Injury Not Work-Related
Your employer or their insurance company might argue that the injury happened outside of work or wasn’t directly related to your job duties. This is common with repetitive stress injuries or when there’s no immediate accident.
Insufficient Medical Evidence
If the insurance company believes your medical records don’t clearly show the cause or severity of the injury, they might deny the claim. In some cases, they may argue the injury is due to a pre-existing condition.
Discrepancies in the Report
If your account of the accident doesn’t match what you told your employer or doctor—or if the employer disputes your story—this can raise red flags and lead to a denial.
Lack of Cooperation
Failing to follow up with medical appointments, ignoring requests for information, or not submitting required documentation can lead to denial based on non-compliance.
Step-by-Step Guide to Appealing a Denied Workers’ Comp Claim in California
If you’ve received a denial letter (also known as a Notice of Denial), you can challenge that decision through California’s workers’ compensation appeals process. Here’s how:
Step 1: Review the Denial Letter Carefully
This letter will state the reason your claim was denied. It’s crucial to understand this reason before moving forward. The denial letter will also include information on how to request a hearing.
Step 2: File an Application for Adjudication of Claim
To begin the appeals process, you’ll need to file an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board (WCAB) in your county. This must be filed within one year of your injury—or within one year of the last benefits payment if you received any.
Step 3: Request a Hearing (Declaration of Readiness)
Once your application is filed, you can request a hearing before a judge by submitting a Declaration of Readiness to Proceed. This initiates the process for a Mandatory Settlement Conference (MSC)—a meeting between you, your employer’s insurance representative, and a judge.
Step 4: Attend the Mandatory Settlement Conference
At the MSC, the judge will try to help the two sides come to a settlement. If that doesn’t happen, the judge will set a date for a trial.
Step 5: Prepare for Trial (If Necessary)
If your case goes to trial, a workers’ compensation judge will hear testimony, review evidence, and make a decision. You’ll need to present all supporting documentation and possibly call witnesses or medical experts.
Step 6: Receive the Judge’s Decision
The judge will issue a written decision after the trial. If the decision is still not in your favor, you have the right to file a Petition for Reconsideration with the WCAB.
Tips to Strengthen Your Workers’ Comp Appeal
If you’re going through the appeals process, there are things you can do to improve your chances of success. Remember, the burden is on you to show that your injury is work-related and that you’re entitled to benefits.
Here’s how to build a stronger case:
📁 Gather All Relevant Documents
This includes:
- Medical records
- Doctor’s notes and diagnostic tests
- Witness statements
- Timecards or work schedules
- Photographs of the accident scene or injury
- Previous communication with your employer or insurance company
Get a Qualified Medical Evaluation (QME)
If your employer or insurer disputes your medical evidence, you may be required to undergo a Qualified Medical Evaluation (QME). This exam is conducted by a state-certified doctor who provides an unbiased assessment of your condition.
Tip: You have the right to choose from a list of approved QMEs—don’t let the insurer choose for you.
Be Consistent in Your Story
Any inconsistencies in your reporting can be used to question your credibility. Make sure your statements to your employer, your doctor, and the WCAB are clear, accurate, and consistent.
Meet Every Deadline
Missing a filing deadline can result in your case being dismissed. If you’re unsure of the timeline, speak with a legal professional who can keep your case on track.
How a Workers’ Comp Attorney Can Help
Workers’ compensation law in California is complicated. Appealing a denied claim is even more complex, especially when you’re dealing with pain, lost income, and mounting medical bills. Hiring an experienced workers’ comp attorney can level the playing field.
Here’s how an attorney can help you:
Investigate the Denial
A lawyer can review your claim, the denial reason, and identify what went wrong. From there, they can build a strategy tailored to your situation.
Gather and Organize Evidence
Attorneys know what documents carry the most weight in appeals—especially medical evidence. They can help you secure strong medical opinions and expert testimony when needed.
Represent You at Hearings and Trial
Legal representation ensures you don’t miss key legal arguments or procedural requirements. Your attorney will handle the hearing or trial process and advocate for your rights.
Maximize Your Settlement
Insurance companies often offer low settlements or push back hard against claims. A workers’ comp lawyer can negotiate on your behalf to ensure you’re not shortchanged.
When to Contact a Lawyer
You should consider hiring a workers’ comp attorney if:
- Your claim has been denied
- You’re being pressured to return to work before you’re ready
- Your benefits have been suddenly reduced or stopped
- You have a pre-existing condition that may complicate your claim
- You’re facing retaliation or termination due to your injury
- You feel overwhelmed or unsure how to proceed
Most workers’ comp attorneys in California, including our firm, offer free consultations and work on a contingency fee basis meaning you pay nothing unless your case is won.
Final Thoughts: A Denial Is Not the End
Being injured at work is hard enough. A claim denial can feel like a slap in the face—but it’s not the end of your journey. With the right information, persistence, and legal support, you can challenge the denial and fight for the benefits you’re entitled to under California law.
At CA Workers’ Compensation Attorney, we’ve helped thousands of injured workers turn denials into approvals. We know the system. We know the tactics insurers use. And we know how to help you get what you deserve.
Contact us today for a free consultation and let us help you move forward with confidence.