Injured and Had Your Workers Comp Claim Denied? Do This Step Next ASAP

Whether you are working at a warehouse, construction project, or manufacturing plant, there is a risk for employee job site injuries. About 2.9 million workplace injuries occur every year and if you file a worker's compensation claim, there's a risk that your claim can be denied.

A job injury or accident can be devastating especially if you have a family to support and bills to pay. It might require time off, physical therapy, a hospitalization, or surgery and your medical bills can quickly pile up. While Worker's compensation insurance benefits can cover medical bills and time off, your worker's comp claim can be denied.

What you might not know is that you can file an appeal if you take these steps ASAP...

File Your Worker's Comp Claim: The Request for Authorization

When you're injured on the job, you have to fill out a worker's compensation application form which is a DWC-1 claim form to request worker's comp benefits while you recuperate.

The DWC-1 claim form is a request for authorization (RFA). This application is sent to your employer and a claims administrator or utilization review (UR) committee. After turning this in (within 30-days), a physician examines you and signs the RFA. Submit it to your employer who can authorize medical treatment as the investigation starts. They will file the claim with their insurance company (within 5-days).

A utilization review committee has 14-days to determine if the requested treatment is medically necessary. They can approve or deny your claim. It can also be delayed if additional medical information is needed.

When Your Claim is Denied

If a claims administrator states that medical treatment is not necessary or your RFA claim is disputed by your employer, meaning, they won't accept liability for your recommended treatment, your worker's comp claim can be denied. A workers compensation attorney can help you challenge the decision.

Your claim can be denied if:

  • Your injury was pre-existing

  • You didn't file the application on time

  • Your worker's compensation application isn't complete

  • You didn't receive medical attention for your injury or illness

  • Your employer believes your injury occurred away from the job

Contest Your Claim Denial

When your worker's comp claim is denied, hire a workers compensation lawyer to "deny or contest your claim".

File an Application for Adjudication of Claim at the DWC office in your county or the county where the injury took place and your employer and the claims administrator must be served with the application.

While you can represent yourself, it's recommended that you hire a Sacramento workers compensation attorney to help you prepare your appeal which goes before a workers compensation administrative law judge.

Schedule a Hearing Before a DWC Judge

  • The DWC office will send a notice in the mail to you confirming they received your application.

  • They'll assign a case number to you.

  • You will file a Declaration of Readiness to Proceed form to request a hearing before a committee at a mandatory settlement conference.

  • You'll go before a judge who will review your case and help you reach a settlement.

If the Conference Won't Settle

If the conference doesn't settle, a trial scheduled for a different date will be held by another judge and you must attend. They will render a decision in writing and send it to you in the mail within 30-90 days. If you disagree with their decision, you have to file a Petition for Reconsideration form.

Hire an Experienced Attorney

Suffering a job injury can be life-altering. If you can't go back to work and you need a Sacramento workers compensation lawyer, contact the Law Office of Roy C. Levin for help with workers compensation. For over 20 years, Roy C. Levin has been representing injured workers. If you need someone to fight for your full benefits and help with your appeal, contact Roy C. Levin today.