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

Can you appeal a claim denied for insufficient medical evidence?

On Behalf of | Oct 21, 2024 | workers' compensation

A workers’ compensation claim can be denied for several reasons, but one of the most common is insufficient medical evidence. If this happens, it is important to know how to appeal the decision. 

There are steps you can take to strengthen your case and improve your chances of a successful appeal.

Understand the reason for denial

The first step in appealing a denied claim is to understand the reason for the denial. If the denial was due to insufficient medical evidence, it means that the information provided did not fully support the injury or its connection to work. Reviewing the denial letter carefully can help identify what specific medical information was missing or unclear.

Gather additional medical evidence

To appeal a denied claim, You may need additional medical evidence. This may involve visiting your doctor again for a more detailed report, seeking a second opinion, or undergoing further tests to provide stronger proof of your injury. In California, it is helpful to work with a doctor familiar with workers’ compensation claims, as they can provide thorough documentation that meets the state’s requirements.

File an appeal

After you gather the missing medical evidence, you need to file an appeal. In California, this involves submitting an “Application for Adjudication of Claim” to the Workers’ Compensation Appeals Board (WCAB). You must file the application within the time frame specified in the denial letter. Missing this deadline can make it harder to get your claim approved.

Attend a hearing

After filing the appeal, a hearing will be scheduled. During the hearing, you will have the opportunity to present the new medical evidence to an administrative law judge. It is important to be well-prepared, as the judge will review all documents and make a decision based on the strength of the evidence provided.

Taking steps to strengthen your appeal

Appealing a denied workers’ compensation claim based on insufficient medical evidence requires several steps. With the right approach, it is possible to overcome the initial denial and receive the benefits you deserve.

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