How to Appeal a Denial of Your Glendale Workers’ Compensation Claim
Workers’ compensation benefits are valuable if you sustain work-related injuries as it covers the financial difficulties you incur. It helps you pay medical expenses to recover and fill your lost income.
Unfortunately, the workers’ comp insurance provider may deny your claim if they think you don’t qualify. For example, they may prove that your injury isn’t work-related or you don’t need medical treatments to recover.
Fortunately, you may appeal a claim denial to prove you deserve the benefits. You only have to know the appeal process and prepare for successful outcomes.
Steps for Appealing a Workers’ Compensation Claim Denial in California
Appealing a workers’ comp claim denial gives you a chance to prove you should receive the benefits for your workplace injuries.
For example, suppose the insurance carrier denies your claim because they don’t believe your injury is work-related. You can file an appeal and present additional evidence proving you got your injuries while working. You also have to efficiently argue against the insurance adjuster as they will try to damage your claim to avoid paying compensation.
Hiring a workers’ compensation attorney in Glendale is thus crucial when appealing a claim denial. They know the evidence you need, represent you in hearings, and help you get the rightful benefits.
Remembering these steps in appealing a claim denial helps you understand the process:
1. Request a Workers’ Comp Appeals Board Hearing
The first step in appealing a claim denial is to request a Workers’ Compensation Appeals Board (WCAB) hearing. You or your lawyer should file an Application for Adjudication of Claim for this request and receive a workers’ comp case number.
You also have to file a Declaration of Readiness to Proceed. Here you will indicate if the claim was denied because the insurance provider believes your injury didn’t:
- “Arose Out of Employment” or while doing work-related activities (AOE)
- Occur during “Course of Employment” (COE)
2. Attend a Pre-Trial Conference
You will then receive a notice containing the place, date, and time of the WCAB hearing. In this informal conference, the presiding judge will try to settle the dispute by checking your claim and evidence.
The judge may set a discovery period of a few days if they think you should present more evidence. They will then decide whether to order the insurance provider to approve your claim or uphold the denial.
3. Filing a Petition for Reconsideration
You may file a petition for reconsideration to the WCAB if you still receive a claim denial from the pre-trial judge. You have 20 days to file the petition upon receiving the pre-trial decision.
The reconsideration process may occur without a hearing, as the WCAB will only review your claim. However, you may provide additional documentation as evidence.
4. Requesting Reconsideration from the State Appellate Court
Now, suppose the WCAB court still gives you an unfavorable decision. The next step is filing a writ for review by the state appellate court, in which the court will order the WCAB to reexamine your case.
If you still receive an unfavorable decision at this point, you may try to submit an appeal to the state supreme court. The problem is that the state supreme court will likely refuse to handle workers’ comp cases.
Consult a Glendale Workers’ Compensation Lawyer for Appealing Claim Denial
Appealing a denied workers’ compensation claim gives you a chance to prove you should receive workplace injury benefits. However, it’s a challenging process, so prepare appropriately for the best outcomes.
A professional workers’ compensation attorney in Glendale will guide you throughout the process and get your claim approved.