My workers' comp claim was denied. What can I do?

You can fight it. A denial is the insurer saying your injury isn't covered. To challenge it, you file an Application for Adjudication of Claim with the Workers' Compensation Appeals Board, and a judge decides. You have one year from the injury or your last benefit to file.

First, look at the letter

Find the date on it and keep the envelope. Deadlines are counted from when the denial was served, so the envelope can matter. Then check when you turned in your claim form. If the insurer took longer than 90 days to deny it, the law already presumes your injury is covered (Labor Code section 5402). And for those first 90 days, the insurer owed you up to $10,000 in treatment whether it liked the claim or not.

A denial stops checks and can stop treatment. It doesn't end anything. Insurers withdraw denials, and judges overturn them.

Sources: DWC Injured Worker Guidebook, Chapter 2; Labor Code § 5402.

What they say, and what actually helps

Common denial reasons and the evidence that answers them

The denial says	What usually answers it
It didn't happen at work	Witnesses, texts or emails from the day, and medical records that say "work injury" from the first visit
You reported it too late	Proof your employer already knew. Under Labor Code section 5402(a), the employer's own knowledge can count as notice
It's a pre-existing condition	A doctor's report on what's causing your problem now, not what you had before
There's no medical evidence	A report that clearly ties the injury to your job, often from a QME
There was no accident	Injuries that build up over time, like repetitive strain or chemical exposure, are covered too. The date of injury works differently for them (Labor Code section 5412)

Two kinds of claims draw denials more than most. Psychiatric injuries have extra legal hurdles (Labor Code section 3208.3), which our page on stress, anxiety and PTSD from work explains. And claims filed after a layoff or firing notice face extra limits for some injuries.

Sources: Labor Code § 5400, § 5402(a), § 5412, § 3208.3.

How a denial ends up in front of a judge

Disputes go to the Workers' Compensation Appeals Board, which hears cases through local district offices. LA County has five: downtown Los Angeles, Van Nuys, Long Beach, Marina del Rey and Pomona. Here's the path, in order:

1. Open the case. File an Application for Adjudication of Claim within one year of the latest of your injury, your last disability check or your last medical benefit (Labor Code section 5405).
2. Get the medical evidence. If the fight is over whether work caused it or how bad it is, a QME or AME examines you and writes a report. That report often decides the case. Our QME guide explains how to get it right.
3. When the case is ready, someone files a Declaration of Readiness. A mandatory settlement conference follows 10 to 30 days later.
4. No settlement? Trial happens within 75 days of the Declaration, and the judge's decision is due within 30 days after that. Some urgent issues get an expedited hearing within 30 days (Labor Code section 5502).
5. Either side unhappy with the decision can ask the Appeals Board to reconsider within 20 days of service, plus 5 more if it was mailed within California (Labor Code section 5903).

Sources: Labor Code § 5405, § 5502, § 5903; 8 CCR § 10605; DWC Guidebook, Chapter 11.

Call (323) 656-9040 or send us the short form to discuss what happened.

While you wait

Write down how and when you got hurt and when you told your employer, today, while you still remember the details. Pull together the claim form, the denial, medical records, pay stubs and names of anyone who saw it. Keep seeing a doctor. If workers' comp isn't paying, use your health insurance and tell the doctor it's a work injury. And don't sign anything the insurance company sends until someone has read it.

If you got fired or lost hours after filing, that's a separate problem with its own deadline. Read about retaliation for filing a claim.

Can you fight it without a lawyer?

Yes, you're allowed to. The state's Information and Assistance officers (1-800-736-7401) explain the process and publish how-to guides for the forms. They can't represent you or argue for you, though, and the insurance company will have lawyers of its own.

A lawyer handles the medical evidence, the QME process, the deadlines and the hearings. In California a judge has to approve the fee, and it comes out of your award, typically 9 to 15 percent of the permanent disability settlement or award according to the state. Nothing up front.

No attorney fee unless you receive benefits. [Firm to confirm cost wording, Rule 7.1 Comment 3: e.g. "You pay no attorney fee unless you receive benefits. Fees are approved by the workers' compensation judge. You [are / are not] responsible for case costs."]

Sources: DWC Injured Worker Guidebook, Chapter 11; Labor Code § 4906.

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