Workers’ Comp Claim Denied? What to Do Next

Q: How long does the insurance company have to deny my claim?

The insurer has 90 days from the date you file your claim form (DWC-1) to accept or deny it. If it does not deny the claim within 90 days, your injury is presumed to be covered, and the insurer can only fight it with evidence it could not have found during those 90 days. The 90 days start when your claim form is delivered to your employer, not when your employer first heard about the injury. That's why you should always file the DWC-1 and keep proof of when you turned it in.

Q: How do I fight a denied workers' comp claim?

Keep the denial letter and every other letter from the insurer. Get a medical-legal evaluation. In a denied case, a state-certified Qualified Medical Evaluator (QME) or a doctor both sides agree on (an Agreed Medical Evaluator, available when you have an attorney) gives an opinion on whether your injury is work-related. File an Application for Adjudication with the Workers' Compensation Appeals Board to open your case. Request a hearing. When you have an attorney, denied claims can go on a priority calendar: a conference within 30 days of the request, a trial set quickly after that, and a decision within 30 days of the trial. Present the evidence: medical reports, witness statements, and your own testimony.

Q: Can I get any income while my claim is denied?

Often, yes. You can apply for State Disability Insurance (SDI) through the California EDD while your workers' comp claim is disputed. If your workers' comp claim is later accepted, EDD is reimbursed from your comp benefits, so you aren't paid twice, but you have income in the meantime. You can also use your own health insurance for treatment, and providers can seek repayment from the workers' comp insurer if you win.

Got a denial letter from the insurance company? It isn’t the final word. Find out how to fight it, the deadlines that apply, and what to do before choosing a medical evaluator. Free consultation, and you pay nothing unless we win.

Call Now: (951) 677-8064

★ 4.6 on Google · Since 2009 · Se habla español

Reviewed by a California workers’ compensation attorney · Updated October 2026

Why do workers' comp claims get denied?

Insurance companies deny claims for many reasons, and a denial does not mean the insurer is right. Common reasons include:

“Not work-related.” The insurer says the injury happened off the job or comes from a pre-existing condition.
Late reporting. The injury wasn’t reported within 30 days, or there was no witness.
Post-termination claims. The claim was filed after a layoff or firing, which has special rules.
Disputed medical evidence. The insurer’s doctor disagrees with your doctor.
Psychiatric claims for workers employed less than six months, or stress claims the insurer blames on a personnel decision.
Paperwork problems, such as an incomplete claim form.

Many of these defenses have exceptions. Injuries that build up over time, like back, shoulder and repetitive-strain injuries, are often wrongly denied as “not work-related.”

How long does the insurance company have to deny my claim?

The insurer has 90 days from the date you file your claim form (DWC-1) to accept or deny it. If it does not deny the claim within 90 days, your injury is presumed to be covered, and the insurer can only fight it with evidence it could not have found during those 90 days.

The 90 days start when your claim form is delivered to your employer, not when your employer first heard about the injury. That’s why you should always file the DWC-1 and keep proof of when you turned it in.

Do I still get medical treatment while my claim is being decided?

Yes. While your claim is under review, your employer must authorize medical treatment up to $10,000. This must start within one working day after you file your claim form. Getting this treatment does not mean the insurer has accepted your claim, but it is still owed to you.

What does a denial letter have to say?

The insurer must send you a written denial that explains the reasons and tells you your rights. If the denial is based on a medical report, a copy of the report must be included. A letter that only says the claim is “under investigation” or “pending” is not a denial.

What is the deadline to challenge a denied claim?

Filing your claim form pauses the one-year deadline. Once the insurer denies the claim in writing, you generally have one year from the date of the denial to file an Application for Adjudication with the Workers’ Compensation Appeals Board. If the insurer paid benefits and then denied the claim later, the one-year clock generally runs from the denial notice. Don’t wait until the last month: medical evidence and witnesses are easier to gather early.

How do I fight a denied workers' comp claim?

Keep the denial letter and every other letter from the insurer.
Get a medical-legal evaluation. In a denied case, a state-certified Qualified Medical Evaluator (QME) or a doctor both sides agree on (an Agreed Medical Evaluator, available when you have an attorney) gives an opinion on whether your injury is work-related.
File an Application for Adjudication with the Workers’ Compensation Appeals Board to open your case.
Request a hearing. When you have an attorney, denied claims can go on a priority calendar: a conference within 30 days of the request, a trial set quickly after that, and a decision within 30 days of the trial.
Present the evidence: medical reports, witness statements, and your own testimony.

Claim denied? Talk to an attorney before you choose a QME.

Call (951) 677-8064

Should I request a QME panel on my own?

Talk to a lawyer first. If you are not represented and you use a state panel QME, that doctor’s evaluation generally becomes the medical-legal evaluation in your case. Hiring an attorney later does not get you a new one. The QME’s opinion often decides a denied claim. With an attorney, you also have the option of agreeing with the insurer on a doctor (an AME) before a panel is requested. A short call before you pick a doctor can make a big difference.

Can I get any income while my claim is denied?

Often, yes. You can apply for State Disability Insurance (SDI) through the California EDD while your workers’ comp claim is disputed. If your workers’ comp claim is later accepted, EDD is reimbursed from your comp benefits, so you aren’t paid twice, but you have income in the meantime. You can also use your own health insurance for treatment, and providers can seek repayment from the workers’ comp insurer if you win.

What if only part of my claim was denied?

Insurers sometimes accept an injury but deny certain body parts, or deny a specific treatment your doctor requested. A denied treatment request usually comes from Utilization Review, and you can challenge it through Independent Medical Review (IMR). You must generally request IMR within 35 days of the Utilization Review decision. Partial denials have different rules and short deadlines, so get advice quickly.

Can I be fired for filing a workers' comp claim?

No. It is illegal in California for an employer to fire, punish or discriminate against you for filing a workers’ comp claim or for being injured at work. If that happens, you may be entitled to additional compensation.

How much does a lawyer cost to fight a denied claim?

Workers’ compensation attorney fees in California are approved by a judge and paid as a percentage of the benefits recovered, usually around 15%, so there is nothing to pay up front and no fee unless we recover benefits for you.

Talk to us about your denied claim

A denial is often the start of the fight, not the end. The sooner you get help, the more options you have, especially before a medical evaluator is chosen.

Call (951) 677-8064 for a free consultation. We help injured workers throughout Riverside, San Bernardino, Orange, Los Angeles, San Diego and Ventura counties. Se habla español.

This page provides general information about California workers’ compensation law and is not legal advice for any specific situation. Every case is different.