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Ghitterman, Ghitterman & Feld Ghitterman, Ghitterman & Feld
805-243-2179
Ghitterman, Ghitterman & Feld Relentlessly Protecting California Workers' Rights Since 1956

California Workers' Compensation Claim Denials

An injury that takes us away from our work has serious consequences. There are medical expenses and lost wages. The workers’ compensation program is there to address those expenses and make us financially whole, but what happens when there’s a denied workers’ compensation claim in California? Ghitterman, Ghitterman & Feld has over 65 years of experience helping injured workers get the help they need and deserve. 

GG&F can be reached by calling (805) 243-2179 or by filling out our online contact form. Free consultations, either in-person or by video, are available.

Top Reasons for Workers’ Compensation Claim Denials

Issues that may arise after a claim is filed may include the following: 

  • The Injury Was Not Job-Related: Workers' compensation only covers injuries arising from and during employment. However, there are cases where this may be a gray area. With more and more work being done remotely, the line between on-the-job and off-the-job is increasingly blurred.
  • Pre-existing Conditions: If a pre-existing condition contributes to or exacerbates the current injury, the claim may be partially or wholly denied. Insurance companies may argue that the pre-existing condition, rather than the workplace incident, is responsible for the injury. The good news is that there is an alternative—the SIBTF program, which helps workers who suffer from pre-existing conditions. Our attorneys can advise regarding options in each specific case.
  • Failure to Receive Medical Treatment: It’s imperative that employees seek out medical care immediately after an injury, even if they don’t believe it to be necessary. The doctor’s report can serve a valuable role as a baseline evaluation. But gray areas can arise when injuries take a long time to develop (i.e., carpal tunnel for a typist or back problems for someone doing heavy lifting). 
  • Failure to See an Approved Medical Provider: For workers’ comp claims, it’s important to consult the Human Resources Department and determine which medical providers are approved for workers’ comp cases. The claim may be denied if an employee seeks treatment from an unauthorized healthcare professional.
  • The Statute of Limitations: California law requires that incidents resulting in an injury be reported within 30 days, and the claim itself must be filed within a year of the incident. But what happens when there is no triggering “incident” per se? The examples above regarding carpal tunnel and back problems are classic scenarios where a denied workers’ compensation claim in California might be unfair based on the circumstances. 

We can help. Call us at (805) 243-2179 for a free consultation.

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    FAQs About Denied Workers' Compensation Claims in California

    What should I do if my claim is denied?

    If your claim is denied, you have the right to appeal the decision. The first step is to file an Application for Adjudication of Claim with the California Workers' Compensation Appeals Board (WCAB). You may also request a hearing before a judge to present evidence supporting your claim. Consulting a workers' compensation attorney can improve your chances of success by helping you gather medical records, witness statements, and other necessary documentation.

    How long do I have to appeal a denied workers' compensation claim?

    In California, you typically have one year from the date of injury to file a workers' compensation claim. If your claim is denied, you must file an appeal promptly. You should request a hearing before the WCAB within 20 days of receiving the denial notice if you want to challenge the decision quickly. Delaying your appeal could make it harder to obtain benefits, so act as soon as possible.

    Can I continue receiving medical treatment if my claim is denied?

    If your claim is denied, the insurance company may stop covering your medical expenses. However, you may still be eligible for treatment through a workers’ compensation lien or personal health insurance while you appeal the decision. Some doctors may agree to treat you on a lien basis, meaning they will get paid only if you win your case. Seeking immediate legal advice can help you navigate your options for continued care.

    Should I get a lawyer if my claim is denied?

    While hiring a lawyer is not required, having a workers’ compensation attorney can significantly improve your chances of overturning a denial. Attorneys understand the appeals process, can negotiate with insurance companies, and help present compelling evidence to the WCAB judge. Since workers' compensation lawyers in California work on a contingency fee basis, they only get paid if you win your case, making legal representation more accessible.

    What happens if I lose my appeal?

    If you lose your appeal at the initial hearing, you may still have options. You can file a Petition for Reconsideration with the WCAB or, in some cases, take your case to the California Court of Appeal. However, each level of appeal has strict deadlines and requirements, so it's important to act quickly and have strong legal arguments. Consulting with an experienced attorney can help you determine the best course of action if your initial appeal is unsuccessful.

    Contact Us Today — It Costs You Nothing

    If you’re having trouble receiving workers’ compensation benefits after a work-related injury, it’s best to consult with an experienced attorney from GG&F as soon as possible. This way, we can help guide you through the process while ensuring that all of your rights are protected. Filing a claim can be difficult, but with the right legal representation, it doesn’t have to be. GG&F has provided legal guidance to workers like you for over 65 years. 

    Contact us today at (805) 243-2179 to schedule an appointment and learn more about how we can help you in your time of need.

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