Problems with your claim

Workers' comp claim denied: what to do next

By the CalCompGuide editorial team · Last updated November 2026 · How we write and check guides

Why claims get denied

• The insurer says the injury didn't happen at work, or didn't happen the way you said.
• The injury was reported late, or after you were fired or laid off.
• No medical evidence links the condition to your job (common with gradual and psychiatric injuries).
• The insurer says you weren't an employee (for example, it calls you an independent contractor).
• Paperwork problems: missing claim form, wrong employer named.

Step 1: Get and read the denial letter

The claims administrator must deny in writing and give a reason. Check the date: if you filed the DWC-1 more than 90 days before the denial, the injury may be presumed compensable under LC §5402(b), and the insurer can only rebut that with evidence it couldn't have found in the 90 days.

Step 2: Keep getting treatment

Use your group health insurance or Medi-Cal; your health plan can seek reimbursement from the workers' comp insurer later. You may also be able to receive State Disability Insurance (SDI) from the EDD while a workers' comp claim is denied; if the claim is later accepted, the payments are coordinated.

Step 3: Use the medical-legal process

If the denial is about whether the condition is work-related, either side can obtain a QME evaluation on that question. If you're unrepresented, you can request a panel with QME Form 105. See QME and AME.

Step 4: File with the WCAB

To have a judge decide, file an Application for Adjudication of Claim. If no benefits were provided, file within one year of the date of injury. Then a Declaration of Readiness to Proceed asks for a hearing. See what happens at the WCAB.

Step 5: Gather evidence

• Your written injury report and the DWC-1, with dates.
• Witness names and statements.
• Medical records showing what you told doctors from the first visit on.
• Photos, schedules, job descriptions, texts or emails about the injury.

Should I get a lawyer after a denial?

A denial is the situation where an attorney most often changes the outcome, because the case now involves medical-legal evidence and court deadlines. Applicant attorneys usually don't charge up front; their fee is approved by a judge and comes out of any award (see fees). The DWC's Information & Assistance officers also help unrepresented workers at no cost.

This guide is general information, not legal advice. Every case is different. For free help from the state, call the DWC Information & Assistance unit at 1-800-736-7401.