If you have filed a workers’ compensation claim and your request was denied, it means your claims administrator has decided that your injury or illness is not covered under California’s workers’ comp policies. Fortunately, that doesn’t mean you should give up just yet.
First, you must figure out the reason why your claim was denied. It should be explained in the denial letter. There are many cases where a denial means failing to meet the eligibility requirements. If, however, you believe the denial was reached due to an error, you may appeal the administrator’s decision.
Common reasons for a denial of workers’ comp benefits include, but not limited to, the following:
- Claim or injury was not filed in a timely manner
- Employer disputes claim
- Failure to receive medical treatment
- Injury is not compensable
- Insufficient evidence that injury is related to job duties
To fight a denial of your workers’ comp claim, you must request a hearing before the Workers’ Comp Appeals Board (WCAB). To do this, you will need to file a form called a “Declaration of Readiness to Proceed (DOR).” Prior to filing this form, however, you will need to have filed an “Application for Adjudication of Claim, which is part of filing you official claim and provides you with a workers’ comp case number.
Once you submit the DOR form, a pre-trial conference may be scheduled. You should receive a notice of hearing which discloses the date, time, and location of the conference. At the conference, the workers’ comp judge will help you attempt to resolve the problem over whether the claim should be accepted or denied.
If the claim cannot be resolved, the case will either go to trial or undergo the “discovery plan” to come up with evidence to help determine the issues in your case. Keep in mind, many disputes over whether a claim should be accepted or denied are settled at the pre-trial conference. In most cases, these cases are accepted by the insurance company.
For more information, contact Wax & Wax, A Law Corporation and speak with our Glendale workers’ compensation attorneys today.
