The phrase “denied claim” will add anxiety and stress to an already-difficult situation, but it is not a reason to panic. California has one of the most robust workers’ compensation programs in the country. It is also one of the largest, and anytime you have something that large, bureaucracy is necessary to keep it afloat. That bureaucratic process means there are many steps along the way that may lead to a denied claim. It also means there are steps in place to try to overcome the denial and potentially receive the benefits to which you’re entitled.
What Does the State Have to Say?
The State of California Department of Industrial Relations has this to say about denied claims: “When a claim is denied, it means the claims administrator believes your injury is not covered by workers’ compensation. If the claims administrator sends you a letter denying your claim, you have a right to challenge the decision. Don’t delay, because there are deadlines for filing the necessary papers.”
The QME Process
When a claim is denied, you may be evaluated by a QME (Qualified Medical Evaluator). You can read our previous blog about QMEs to learn more. Essentially, a QME examines an injured worker to determine the benefits they’ll receive. This guidebook may be of help.
The Appeal Process
may want to have an attorney represent you. The advantage of hiring an attorney is you’ll have an experienced attorney and her team on your side who navigates the workers’ compensation world on a daily basis. You can always reach out to us to determine if working with an attorney is the right choice for you.
