Denied Workers’ Compensation Claim Attorney in Van Nuys, CA
An insurer may deny an entire claim (disputing that the injury is work-related or happened at all) or deny a specific piece of treatment or benefit while otherwise accepting the claim. Both types of denial can be challenged. A denied claim can be taken to the Workers’ Compensation Appeals Board (WCAB) for a hearing before a workers’ compensation judge; a denied treatment request generally goes through Utilization Review and then Independent Medical Review.
Key Points
- Common reasons insurers deny claims include disputes over whether the injury happened at work, missed reporting deadlines, or conflicting medical opinions
- A denial letter should state the reason for denial and your appeal rights — reading it carefully is the first step
- Strict deadlines apply to appeals, so prompt action after a denial matters
- Medical evidence — your own treating physician’s records, and if needed, an independent evaluator’s opinion — is usually central to overturning a denial
Considerations
- A denial is sometimes based on an incomplete or inaccurate account of how the injury occurred — correcting the record early can matter
- Insurers are required to accept or deny a claim within statutory timeframes; an unreasonable delay can itself have consequences
- Representation becomes more valuable, not less, once a claim is contested, since the process shifts toward formal litigation before the WCAB
California Law Note
An employer or insurer generally must accept or deny liability for a claim within 90 days of receiving a completed claim form; if no timely decision is issued, the claim may be presumed compensable subject to limited rebuttal (Labor Code § 5402).
Related Questions
How do I know if my injury is covered by workers’ compensation?
Most injuries and illnesses connected to your job duties are covered, whether from a single accident or from repeated activity over time (cumulative trauma). Coverage questions are fact-specific — the most reliable way to find out is a free case evaluation, where the facts of how and when the injury happened can be reviewed directly.
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Attorney Advertising. Prior results do not guarantee a similar outcome. This page is general information, not legal advice, and does not create an attorney-client relationship.
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