Denied Workers' Comp in California? Appeal Options and Mistakes to Avoid

 Posted on August 29, 2023 in Workers' Compensation

If you have had a workers' compensation claim denied in California, you still have options. The process can be confusing, but understanding your rights and avoiding common mistakes will help your appeal succeed.

Overview of the Appeal Process

If your initial workers' comp claim is denied by your employer's insurance company, keep trying. California law provides multiple levels of appeal to fight a denial. First, you can request the insurer reconsider the decision. New evidence can be submitted. Here are the next steps:

Hearings

If reconsideration fails, request a hearing with the Workers’ Compensation Appeals Board (WCAB). A workers' comp judge will review evidence and make a binding decision.

Reconsideration of the WCAB decision: If you disagree with the hearing decision, you can request WCAB reconsider its ruling. This is only granted in limited circumstances.

Appeals

The final step is appealing the WCAB decision to the California Courts of Appeal and potentially the Supreme Court. Very few cases reach this level.

At each stage, workers' comp attorneys and evidence play a major role in overturning unfavorable rulings. Mistakes can also derail appeals, so understanding common errors is critical.

Avoid These Common Mistakes in the Appeal Process

Here are key mistakes that can sabotage a workers' comp appeal in California:

Missing deadlines: Strict filing deadlines apply at each stage of appeal. Miss the 30-day window for reconsideration or not filing court appeals on time can ruin your case.

Failing to submit medical reports: Solid medical evidence is crucial. Making sure qualified doctors review your case and submit supportive reports is key.

Not having an attorney: An experienced workers' comp attorney knows how to navigate the appeal process and present persuasive arguments. Going it alone is risky.

Providing inconsistent facts: Changing your story or providing conflicting descriptions of the injury can damage your credibility. Stick to consistent facts throughout the appeal.

Appearing uncooperative: Refusing to submit to medical exams requested by the insurer or failing to provide documentation makes you appear unreasonable. Cooperate fully.

Avoiding these mistakes takes diligence and working closely with an attorney. With persistence and the right evidence, many initially denied workers' comp claims are eventually overturned on appeal. Do not give up if your claim is denied—know your rights and explore every option to get benefits you deserve.

Contact a San Bernito County Workers' Compensation Lawyer

If you are considering an appeal of a workers' comp denial, contact a California injury attorney. You can navigate the appeal process with someone experienced on your side. Call Cramer + Martinez at 408-848-1113 for a free consultation to see which next steps you should take.

Source:

https://www.dir.ca.gov/DIRNews/2022/2022-01.html