Attorney Esequiel Solorio is a certified specialist in workers’ compensation law as certified by The State Bar of California Board of Legal Specialization.

What should I do if my workers’ compensation claim is denied?

On Behalf of | Apr 6, 2017 | workers' compensation

Workers’ compensation claims can be complicated to file, and denials are common for a variety of reasons. As in other states, the California system values cost effectiveness and strict adherence to procedure. For this reason, claims can be denied due to faulty or incomplete paperwork, missed deadlines or insufficient documentation. In other cases, you may get benefits that do not provide adequate compensation.

Hearing before local board

The good news is that if you disagree with the decision on your claim, you have ways to challenge that decision. The first step is to ask for a hearing with your Workers’ Compensation Appeals Board, where you and your attorney can offer arguments and documentation to show that the initial determination was wrong.

Petition for Reconsideration

If the local WCAB decides against you, you can appeal to the central appeals board in San Francisco. You will need to file a Petition for Reconsideration. Unlike the appeal to the local board, this petition is handled entirely through email. Because there is no hearing, you will need to make sure you submit a full and complete set of documentation.

Not all types of local determinations can form grounds for reconsideration. Just disagreeing with the board’s decision is not enough. The San Francisco board will only consider your petition if it shows that the local board’s decision fails to take into account or properly interpret the evidence you submitted or if you have found new evidence that you had no possibility of discovering before the initial hearing.

A Petition for Reconsideration should include your evidence and arguments. You will also need to include legal arguments that rely on knowledge of statutes and decisions in other cases. Therefore, many people attempting an appeal prefer to hire counsel even if they filed the initial claim on their own.

State appellate court

Once the San Francisco board issues its ruling, you or your employer’s insurer can petition the California appellate court for a writ of review. This type of appeal is strictly limited. The appellate court must accept the board’s determination of the facts in the case. It can only review whether the board’ s decision was legally reasonable. The chances of prevailing before the appellate court are fairly low in most cases.

If you receive a workers’ compensation decision you do not agree with, you do not have to settle for it. The appeals process is highly detail -intensive and often involves complex legal arguments. For this reason, it is best to retain a qualified workers’ compensation lawyer whose experience and knowledge of applicable law can help you achieve the results you need.