How Do You Appeal a Denied California Workers’ Compensation Claim?

 Posted on August 30, 2025 in Denied Claims and Appeals

If you were hurt on the job and your workers’ compensation claim was denied, you may feel frustrated and unsure of what to do next. Thankfully, California law provides clear steps for challenging the denial and fighting for the benefits you need. With the right approach and the help of a Hollister, CA workers’ compensation attorney, you can appeal the decision and keep your case moving forward.

Understanding Why Your Workers’ Comp Claim Was Denied

Insurance companies deny claims for many reasons, some valid and others questionable. A denial might happen if your employer argues that your injury was not work-related or if your medical records do not support your version of events. Sometimes, a claim is rejected simply because the paperwork was incomplete or you missed a deadline.

California law also sets strict requirements for filing claims. For example, under Labor Code § 5401, an injured worker must notify their employer about their injury using a claim form, known as a DWC-1. If this notice is late or missing, it can give the insurance company grounds for denying benefits.

Legal Steps to Appeal a Denied Workers’ Comp Claim in California

If your claim is denied, you have the right to challenge the decision. The process includes several stages, and knowing what to expect can help you stay prepared:

• Apply for adjudication of claim: This starts your official case with the Workers’ Compensation Appeals Board (WCAB) and gives you a case number.

• Attend a mandatory settlement conference: Both sides share evidence such as medical reports and may attempt to reach an agreement before trial.

• Go to trial if necessary: If a settlement is not reached, a judge reviews the facts and issues a decision. First, they will hear testimony and examine the documents.

• Request an independent medical review (IMR): Under Labor Code § 4610.5, you can challenge a denial of medical treatment by asking an independent doctor to review the case.

• File a petition for reconsideration: If you disagree with a judge’s ruling, Labor Code § 5900 allows you to request a further review by the WCAB.

Do You Need a Lawyer To Appeal a Workers’ Compensation Claim Denial in California?

While it is possible to represent yourself, many workers find the appeal process overwhelming. Insurance companies have skilled lawyers, and the rules for hearings and evidence can be hard to follow. A workers’ compensation attorney knows how to collect proof, use medical records, question witnesses, and point out errors by insurers.

An attorney can also ensure that all forms are filed correctly and on time, reducing the chances of delays or missed opportunities. In many cases, having legal representation improves your chances of success, especially when your injury is serious or the insurance company is aggressively disputing your claim.

Contact a San Benito County, CA Workers’ Compensation Attorney Today

If your workers’ compensation claim has been denied, do not lose hope. You still have the right to appeal and fight for the benefits that cover medical treatment and lost wages. Our Hollister, CA workers’ compensation lawyers can guide you through each step, from filing your appeal to representing you before the WCAB.

At Cramer + Martinez, our firm has proudly supported injured workers for nearly 30 years. Our team brings more than two decades of combined experience in California workers’ compensation law to every case we handle. With local knowledge and dedication, we are ready to stand up to the insurance companies and protect your rights. Call 408-848-1113 now to schedule a free consultation and start fighting for the benefits you need. We also provide services in Spanish.