What to do if your workers’ comp claim is denied

Workers’ compensation insurance is designed to protect employees that get injured on the job. Employees are eligible for medical expense coverage, lost wage reimbursement and rehabilitation cost coverage due to illness or injury caused by work-related incidents.

If you get injured while doing your job, you may be eligible for workers’ compensation and expect coverage for your medical expenses and lost wages—but your claim could be denied.

Why your claim was denied

There are several reasons why your workers’ compensation claim may be denied. Your denial letter should explain why your claim was rejected. You can appeal your claim if you believe your injury meets the workers’ compensation claim requirements.

Here are some common reasons why claims are denied:

• The employee missed the deadline: You should report your injury to your supervisor as soon as possible. In California, if you do not report your injury to your employer within 30 days, you may not be eligible for workers’ compensation.
• The employer disputed the claim: Your employer may dispute the claim if they believe that your injury did not happen at work and is not due to the nature of your job. Or, if your employer claims that the injury was due to misconduct, your claim may be denied.
• The employee did not receive medical treatment: You must receive medical treatment in order for your claim to be eligible for workers’ compensation. If you do not get your injury evaluated by a physician, your claim will likely be denied.

Appeal the denial

You can appeal your claim if it has been denied. The denial letter will give you a timeframe in which you can file an appeal. You will want to collect as much evidence as you can before filing your appeal—make sure you do not miss the deadline.

You may want to speak with your employer about the denied claim before appealing. It is possible that your claim was denied in error and that it can be quickly resolved. If your appeal was not received in error and your employer stands by the denial, you may choose to appeal.

Appealing a denied workers’ comp claim involves a complicated legal process. Under California law, you must dispute your case in front of a judge. It may be best to hire an experienced workers’ compensation attorney because the appeal process is complex.