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My Workers' Comp Claim Was Denied. What Now?


When you’ve been injured in the workplace, you are most likely entitled to receive worker’s compensation benefits through your employer’s insurance provider. However, many workers’ comp claims are denied the first time – and the denial may not be based on an accurate or rational basis.

If your California workers’ comp claim has been denied, you still have options. At the Law Offices of Larry S. Buckley, we can help you explore all those options and determine what will work best for your unique circumstances. Our workers’ comp law firm has been in business since 1999, and we take great pride in helping our injured clients get the resources they need to recover.

Here’s how we can help you navigate a workers’ comp claim after it has been denied.

Why Was My Claim Denied?

There are a number of reasons that your claim may have been denied by an insurer, and while some of these are perfectly valid reasons under the law, others may not be accurate for your situation. Usually, the insurance company will send you a “denial letter” detailing one of the reasons why your claim was dismissed, but there could also be other reasons behind the scenes too, as a claim can be denied on multiple grounds.

Here are some of the most common justifications for denial:

  • You were terminated by your employer. Some insurers will cite California Labor Code Section 3600 and use your termination as an excuse for a denial, without fully investigating the facts of your injury claim. However, you may still be entitled to recovery for injuries on-the-job, depending on the circumstances of your termination.
  • There’s a lack of medical evidence for your injury. Establishing your injuries with a medical expert is critical to any workers’ compensation claim. If the insurer thinks that there is not enough medical evidence to connect your injury with your work activities, they may issue a denial without fully reviewing your case.
  • You waited too long to report the injury to your employer. This is by far one of the most common reasons for claim denial, as you are required to report your injury within 30 days in California. That being said, there are many injuries that take time to develop, such as “repetitive stress injuries” or cumulative trauma, and these may actually be covered by workers’ comp.
  • There’s a lack of “factual” evidence for your workplace accident. In addition to medical evidence, you must also have factual evidence that shows your exposure to an unsafe work condition, or shows an accident took place. Without sufficient detail in this area, the insurance provider may issue a denial.
  • Your employer disagrees with the circumstances of your claim. Sometimes, your employer may try to dispute your claim, or say that you were not engaged in “work-related activities” at the time of your accident. While the insurance company is supposed to look at your claim with an impartial eye, in reality they often rely on employers to determine an outcome.
  • Your particular injury is not compensable. Not all injuries will be covered under workers’ compensation, particularly if they were caused by “horseplay,” intentional wrongdoing, or other non-work activities. Stress-related injuries are also notoriously difficult to prove on workers’ comp claims.

How Do I Begin the Appeals Process?

No matter what reason you’ve been given for a claim denial, you retain the right to appeal with the California Division of Workers’ Compensation. You will need to file an application to adjudicate your claim with the CWC Appeals Board, and the statute of limitations for an appeal is one year. Eventually, you will be able to attend a hearing with a judge for workers’ comp, and present evidence and witnesses for your case.

Because it can be very grueling to go through the appeals process alone, it’s strongly recommended that you hire a workers’ comp attorney at the outset of your claim – or as soon as you receive a claim denial. Our team at the Law Offices of Larry S. Buckley has vast experience preparing for hearings, trials, and legal proceedings of all kinds, particularly in the realm of workers’ compensation. Intimately familiar with the process for a workers’ comp appeal, we’ll fight on your behalf and give you the dedicated representation that you deserve.

For more information about the workers’ comp appeals process, call (530) 413-0245 today.

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