If you receive a claim denial from workers’ compensation in California, you do have options. You do not have to accept the denial as it is without trying to get a further explanation or trying to get the denial reversed. Generally, according to the Department of Industrial Relations, a denial means the administrator found your injury was not a covered injury under workers’ compensation rules.
You should be aware that while you have actions you can take, there are deadlines you must meet. If you wait too long to fight a denial, then you lose the opportunity to do so. You can challenge the initial decision by filing a case to go in front of a workers’ compensation administrative law judge.
You may file your case at a division office. There are 24 in the state, but you must file at the office in the county in which you live or you can file in the county where you were injured if it is different. You will file an Application for Adjudication of Claim to start your case.
After filing this, if you wish to have a hearing, you need to file a Declaration of Readiness to Proceed. This will get you on the court docket. At the hearing, you and the administrator will present your cases to the judge. The judge will try to get you to settle before making a final ruling. If you cannot settle, the judge sets a trial date. You must attend the trial to present your case. The judge at trial will issue a ruling in writing about 90 days after the trial. This information is for education only and does not constitute legal advice.
