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What happens if my claim is denied?

As an employee in California, you are entitled to certain rights under the law if you are injured during the course of work. In some cases your workers’ compensation claim may be denied, but fortunately you can appeal the decision if you feel it was made in error. To this end, it’s important for you to be aware of the steps involved in appealing a denied claim in order to have the best chance of success.

According to the State of California Department of Industrial Relations, workers whose claims were denied can file an appeal on their own or seek the assistance of an attorney. In any case, timely filing of your appeal is crucial to ensure you’re within the allotted timeframe. You will receive a letter informing you of your denied claim, and you must respond before the deadline to move on to the next steps.

For your appeal to be heard before a court, you must file a document known as Application for Adjudication of Claim. California has 24 separate offices tasked with processing workers’ compensation claims, so you must find the one in your area and file your appeal there. You should receive a formal response stating that your appeal was received, and ultimately you will have a trial where the validity of your claim will be reviewed.  

It’s also possible that you and the physician tasked with assessing your injuries have a disagreement about your ability to continue working. This requires the assistance of a qualified medical evaluator, who must possess the right training and background in order to be eligible for the role. This doctor will offer an additional opinion on whether your injuries are work-related, and if they are severe enough to keep you from working.

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