What to Do If Your Workers’ Compensation Claim Is Denied in California

When you are injured at work, you expect workers’ compensation to provide a safety net — covering medical care, part of your wages, and other benefits while you recover. Unfortunately, many workers in California face the frustration of receiving a claim denial instead of the support they desperately need.

The good news is that a denial is not the final word. Workers have the right to appeal, present additional evidence, and fight for the benefits they deserve. At California Trial Law Group, we regularly guide injured employees through this difficult process, helping them turn setbacks into successful outcomes.

Why Workers’ Compensation Claims Get Denied

Insurance companies deny claims for many reasons — some legitimate, others unfair. Common grounds for denial include:

• Disputes about work-relatedness – The insurer may argue that your injury happened outside of work or during personal activities.
• Missed reporting deadlines – California law requires prompt reporting of workplace injuries. Waiting too long can give insurers a reason to reject your claim.
• Pre-existing conditions – If you had a prior injury or medical issue, insurers often try to blame your current condition on that instead of your job.
• Lack of medical documentation – Incomplete or inconsistent medical records can give insurers grounds to deny.
• Employer disputes – Sometimes employers deny the injury ever happened at work, putting the worker in a difficult position.
• Technical errors – Even small mistakes in paperwork or forms can trigger a denial.

In many cases, denials are less about the facts and more about saving the insurance company money.

Real-World Examples of Denied Claims

• A warehouse worker develops chronic back pain from years of heavy lifting. The insurer denies the claim, blaming it on “normal aging” rather than workplace strain.
• A nurse slips on a wet hospital floor but doesn’t report the accident until days later. The claim is denied due to a “late report.”
• A delivery driver is hit by another car while making a delivery. The employer insists he was “off route” and the injury wasn’t work-related.

These examples show how insurers use technicalities and disputes to avoid paying benefits.

Immediate Steps After a Denial

If your claim is denied, take action quickly to protect your rights:

1. Review the denial letter carefully – It should explain the reason for denial.
2. Gather supporting evidence – Collect medical records, accident reports, witness statements, and emails or texts that confirm your injury.
3. Consult with your doctor – Make sure your physician clearly links your injury to your work duties.
4. Track all deadlines – California workers’ compensation appeals are time-sensitive, and missing a deadline can end your case before it starts.
5. Speak to an experienced attorney – A lawyer can identify weak points in the denial and help you build a strong appeal.

The California Appeals Process

Appealing a denied claim involves several stages before the Workers’ Compensation Appeals Board (WCAB):

• Filing an Application for Adjudication of Claim – This step officially opens your case at the WCAB.
• Mandatory Settlement Conference (MSC) – You and the insurer attempt to resolve the dispute. If no agreement is reached, the case moves forward.
• Trial before a workers’ compensation judge – A judge reviews evidence, hears testimony, and issues a decision.
• Petition for Reconsideration – If you disagree with the judge’s ruling, you can request a higher review.

This process can be intimidating, especially when insurance companies bring in lawyers to protect their interests. That’s why representation from a workers’ comp attorney is so important.

How California Trial Law Group Helps Injured Workers

At California Trial Law Group, we fight aggressively for workers whose claims have been unfairly denied. Our team:

• Analyzes the denial letter to uncover flaws in the insurer’s reasoning
• Works with doctors to strengthen medical documentation
• Collects workplace evidence, including safety reports and witness testimony
• Represents clients at settlement conferences and hearings
• Negotiates directly with insurers to push for fair settlements
• Pursues further appeals when necessary

Attorney Ike Kaludi and his team have years of experience taking on employers and insurers who put profits before people.

Benefits You May Still Be Eligible For

Even if your initial claim was denied, a successful appeal may secure benefits such as:

• Medical treatment – Doctor visits, surgeries, rehabilitation, and prescriptions.
• Temporary disability payments – Partial wage replacement while you recover.
• Permanent disability compensation – Long-term support if you cannot return to your job.
• Supplemental job displacement benefits – Financial assistance for retraining if you need a new career.
• Death benefits – Support for surviving family members of workers who lost their lives.

These benefits can provide crucial financial stability during a very uncertain time.

Common Mistakes to Avoid After a Denial

Many workers unintentionally hurt their own cases by:

• Waiting too long to appeal
• Relying solely on the insurance company’s word
• Failing to get medical treatment after denial
• Assuming they cannot afford a lawyer (most workers’ comp attorneys, including us, work on contingency fees)

Avoiding these mistakes can significantly improve your chances of success.

Don’t Give Up After a Denial

Being told “no” after filing a workers’ comp claim can feel like the end of the road — but it doesn’t have to be. With persistence, evidence, and skilled legal help, many workers successfully overturn denials and secure the support they need.

At California Trial Law Group, we believe injured workers deserve fairness, not excuses. If your workers’ compensation claim was denied, contact us today. We will review your case, explain your options, and fight for the benefits you and your family need to move forward.