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What Can You Do About a Workers’ Comp Claim Denial?

An attorney can review your claim denial and advise whether to appeal the decision regarding your claim.

The Workers' Compensation Appeals Board (WCAB) contains seven members whom the California Governor appoints and the Senate confirms. The main purpose of the board is to review petitions for reconsideration by workers' compensation administrative law judges. Three different stages exist for appealing a claim denial with each appeal going to a higher level for review:

  • Appeal to the WCAB through a petition for reconsideration
  • Writ of review to an appellate court
  • Appeal to the California Supreme Court

The WCAB panel made a significant decision in 2014 in the case of Eun Jae Kim vs. B.C.D. Tofu House, Inc., Cypress Insurance Company, et. al. The plaintiff alleged that she suffered cumulative back injury and other bodily injuries from her work as a waitress manager. The case addressed the fact that her request for an expedited hearing was wrongfully denied.

Under the Labor Code, when you submit a workers' compensation claim, the employer must provide up to $10,000 of medical treatment within its Medical Provider Network (MPN) until the date that liability for the claim is rejected. An expedited hearing would address matters such as whether the injured employee must obtain treatment within a medical provider network. Initially, the plaintiff Eun Jae Kim chose a physician that was out of network. A 90-day period exists to request an expedited hearing, but once the hearing is denied, no recourse is available under the WCAB. In this particular case, although the WCAB ruled that the administrative judge should have allowed the expedited hearing, the employee had to take her case to the appellate court level.

If you suffered a serious injury, consulting with a skilled workers' compensation lawyer can help you avoid unnecessary delays and obtain your rightful benefits.

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