When you file a workers’ compensation claim in California, you usually receive a decision about whether your claim was accepted within 90 days. Lack of response within 90 days counts as the claim being accepted. If your claim is denied, the Division of Workers’ Compensation will notify you of this decision no more than 90 days after you file form DWC-1. As disappointing as it may be to see your claim denied, it does not automatically mean that your only options for paying your medical bills are to borrow money or try your hand at crowdfunding. A workers’ compensation judge (WCJ) will re-examine your claim and may decide to have workers’ compensation cover your medical expenses. Some injured people represent themselves when getting their workers’ compensation claims adjudicated, but others choose to hire a workers’ compensation lawyer.
When you find out that your claim was denied, the first step is to see a Qualified Medical Evaluator, a physician who has not been involved in your treatment but who is certified in reviewing workers’ compensation claims. The QME can give you a second opinion and advise you on how to present your case when applying for adjudication. You must them file an application for adjudication of claim. The information on this form is similar to that on the DWC-1 form, but more detailed. File one copy of the application for adjudication of claim with the court in your county and give another copy to your employer.
When the court receives your application for adjudication of claim, they will assign you a case number and give you instructions on how to prepare for your hearing. It is a good idea to hire a lawyer to help you prepare. When you are ready for a hearing, file a Declaration of Readiness to Proceed. The court will schedule a hearing called a Mandatory Settlement Conference. If you and your claims administrator do not reach an agreement during this hearing, your case will go to trial. It is almost always necessary to hire a lawyer to represent you at the trial and during the time leading up to it, even if you have been representing yourself until the Mandatory Settlement Conference.
Dealing with denied claims is not the QME’s only task. A QME can also help you if the Division of Workers’ Compensation has accepted your claim, but there is a dispute about which treatments they will cover or how much money they will allocate for your medical care.
The safest choice is to consult a workers’ compensation lawyer as soon as you receive notice that your claim has been denied, even before the QME reviews your claim. Your lawyer can help you understand the legal implications of details that others involved in the process. They might even advise you about other ways of recovering compensation for your medical expenses, besides workers’ compensation.
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The work injury law firm of Los Angeles Workers' Comp Attorneys help clients who have been injured on the job to navigate the Federal workers' compensation system and get the benefits they are entitled to. This may include filing and appealing claims, negotiating with insurance companies, and representing clients in hearings and appeals. Our workers' comp lawyers serve all cities and courts throughout Los Angeles and may also help clients who have been denied benefits or whose benefits have been terminated. Additionally, we may provide guidance on issues related to job retraining and disability benefits, and may also assist clients in seeking additional compensation through third-party... View full business profile here: Los Angeles Workers' Comp Attorney
