Workers’ compensation is a no-fault system, which means that most of the time, if you file a claim, you will get an approval. However, there may be a situation wherein the administrator does not feel that workers’ compensation covers your claim. If you receive a denial, you can challenge the decision through an appeal.
The State of California Department of Industrial Relations explains that you have a limited amount of time to file your appeal. You must open a case, which will go in front of a judge. All cases go through a workers’ compensation administrative law judge. You do not get the right to a jury.
To start the process, you must file an application for adjudication of claim at your local workers’ compensation office. You will then get a notice from the DWC office of your case filing. You must then file a declaration of readiness to proceed form to have the DWC schedule your hearing. You must also inform the other parties in the matter, such as the claims administrator.
At the hearing, the judge will look over your case and discuss the details with you and the claims administrator. The goal is to reach a settlement, but if you do not settle, the judge will set a date for a trial. At the trial, a judge will render a decision and deliver it to you in writing by mail.
The final judge’s decision
If you still do not get the results that you desire from the judge’s ruling, then you can file a petition for reconsideration. This will allow you to have a judge look over your case again and render a new ruling.
Challenging a workers’ compensation decision can take months. It depends on how far you go in the process. If you can reach a settlement with the claims administrator, then that is usually the fastest option.