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3 steps to take after a claim denial

On Behalf of | Jan 6, 2024 | Workers' Compensation |

Getting injured on the job can be a daunting experience, especially when you receive a denial on your workers’ compensation claim.

It is important to stay calm and take proactive steps to address the situation. In California, understanding the proper course of action can make a significant difference in securing the benefits you deserve.

1. Request your claim file

When faced with a denied workers’ comp claim, the first step is to request a copy of your claim file. This document contains important information about your case, including medical reports and statements from both you and your employer. By reviewing this file, you can identify any discrepancies or missing details that potentially led to the denial.

2. Seek a second medical opinion

In California, you have the right to seek a second medical opinion after a workers’ comp claim denial. Schedule an appointment with another qualified medical professional to reevaluate your injuries and provide an independent assessment. Ensure that the new examination covers all aspects of your condition, leaving no room for ambiguity.

3. File an appeal

If all else fails, and you believe your claim is legitimate, file an appeal with the California Workers’ Compensation Appeals Board. Follow the appeal process diligently, adhering to all deadlines and requirements. Provide all requested information, including the details obtained in the previous steps. The appeal process is your opportunity to present a compelling case for the reconsideration of your workers’ comp claim.

In 2022, 419,300 nonfatal workplace injuries and illnesses occurred across California. For many, those injuries lead to days away from work. While a claim denial is stressful, injured employees have options to obtain the benefits they rightfully deserve.