Denied Workers’ Compensation Cases

If your workers’ compensation claim is denied by the insurance company, it can be frustrating and overwhelming. You may be thinking if the injury occurred at work how can the insurance company deny my workers compensation claim? Rest assured, there is a process in place to appeal a workers’ compensation denial and ensure that you get the compensation you deserve and the experienced attorneys of the RSnyder Law Firm, PC can help you fight the denial.

Insurance Denial

Sadly, some insurance companies routinely deny workers’ compensation claims, assuming that the injured worker will drop the matter and simply deal with their injury on their own. But an insurance company may legitimately deny your claim if they believe the injury wasn’t work-related or happened while you were working for another employer. They might also deny your claim if they determine you don’t need medical treatment or that you don’t need time off of work to recover. If an insurance company denies your claim, they should state the reason. If you disagree, you can appeal their decision. Do not try to fight the insurance company on your own. The talented attorneys of the RSnyder Law Firm, PC have been fighting insurance companies for years with excellent results. Let our firm help you. We will handle the Workers Compensation Appeal Process and fight for you to ensure you are given the benefits and treatment you are entitled to under California Law.

The Appeals Process

1. Local Workers Compensation Appeals Board Hearing

In California, the first step after receiving a denial is to request a hearing in front of your local Workers’ Compensation Appeals Board (WCAB) judge. Your dispute is with your employer’s workers’ compensation insurance company, not with your employer. So, you shouldn’t feel hesitant about appealing. You may want to file an appeal even if the insurance company accepted your claim. For example, if they don’t agree with the treatment plan subscribed by your doctor or if your short-term disability payments are too low.

To determine whether workers’ compensation covers your claim and whether the insurance company should pay for it, the judge will hold a hearing, like an informal trial, to hear from both sides. To begin the process, you or your attorney will need to file a Declaration of Readiness to Proceed, which you can only file after you have filed your Application for Adjudication of Claim and received a workers’ compensation case number.

2. Appeal to the Full Workers’ Compensation Appeals Board

If you don’t agree with the decision of the WCAB judge, you can appeal to the full seven-member Workers’ Compensation Appeals Board in San Francisco. Unless you have new evidence, the WCAB will probably decide your case without a hearing. You will need to act quickly because you only have 20 days from the date you receive your WCAB judge’s decision to appeal.

3. California Appellate Court

If you are unhappy with the determination of the full WCAB, you can appeal to the California Court of Appeals in the appellate district where you live, requesting a “writ of review.” The appeals court scope is limited, however, and it can only determine if the appeals board decision was reasonable given the facts at hand.

4. California Supreme Court

If the appellate court denies your claim, you can appeal to the California Supreme Court.

As you can see, the process of filing an appeal can be complicated with strict time limits. To ensure that you meet all of the workers’ compensation deadlines and can file an effective appeal, you should consult an experienced California workers’ compensation attorney as soon as possible. We can help. Give us a call at (949) 484-0175 to schedule a free consultation. The professionals at the RSnyder Law Firm have over 10 years experience and are skilled at negotiating with insurance companies and at litigating workers’ compensation cases when necessary to protect the rights of our clients.


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