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What options exist when a workers’ compensation claim is denied?

Posted on September 23, 2015 in Workers' Compensation


Things do not always come easy for Los Angeles residents. When a person sets a goal, it is often met with several obstacles and challenges along the way that must be overcome in order to achieve that goal. Ultimately, with perseverance and the right set of skills, however, the individual may accomplish the goal.


This is certainly true when it comes to the legal system. When a person’s legal rights suddenly are threatened, there can be many challenges to enforcing those rights and getting the legal relief the person deserves.

For instance, when a job injury occurs, individuals have certain rights to workers’ compensation. As discussed last week in this blog, workers’ compensation can provide a financial lifeline for those who are unable to work because of a workplace accident.

However, obtaining workers’ compensation is not always a simple one-step process. A claims administrator may deny a person’s initial claim after concluding an injury is not covered by workers’ compensation. While this denial is unfortunate, it is not the end of the road, as individuals have the ability to press on and challenge that decision.

There are many issues that can arise in a denial. For instance, sometimes the claims administrator may disagree with a treating physician’s reports as to a person’s injury. Under these circumstances, the individual may be evaluated by a qualified medical evaluator. In other cases, the person may appeal the decision, where a formal process will follow that allows resolution of the dispute. This resolution may include reaching a settlement between the different sides, or it can proceed to a trial where both sides present their case to a judge.

Even after a judge makes a decision, there might be further avenues to challenge the decision, such as asking the judge to reconsider an unfavorable decision. Accordingly, individuals who have had a claim denied should understand their rights to continue on in the case, which may make all the difference between obtaining workers’ compensation or not receiving anything.

Source: Department of Industrial Relations, “If my claim was denied,” accessed on Sept. 19, 2015