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Can one appeal a denial of workers' compensation benefits?

Workers' compensation benefits can be a crucial financial lifeline for workers in California who are injured on-the-job, and cannot return to work due to their injuries. When a worker wants to pursue workers' compensation benefits, they will file a claim. Unfortunately, sometimes, a person's claim for workers' compensation benefits is denied. But, that denial can be challenged.

First, the worker will file a claim at their local Division of Workers' Compensation (DWC) office, where a judge will make a decision on the claim in a trial court. To file a claim, the worker must submit to their DWC office an Application for Adjudication of Claim.

Once the DWC office receives this application, they will notify the worker that the worker's claim has been filed. The notification will also contain the worker's case number. Following that, the worker needs to submit a Declaration of Readiness to Proceed. After that a hearing known as a mandatory settlement conference (MSC) will be scheduled.

At the MSC, the judge will hold a discussion with the worker and the claims administrator in an effort to settle the matter. If that is unsuccessful, the worker needs to execute paperwork that summarizes the dispute and identifies what evidence and witnesses will be presented at trial. A trial date will be scheduled.

A judge separate from the MSC judge will preside over the trial, which the worker must appear at. That judge will make a decision, and the worker will receive the judge's written decision around 30 to 90 days following the trial. If a worker does not agree with the judge's ruling, the worker can submit a Petition for Reconsideration.

This is only a brief overview of what a worker can do to challenge a denial of benefits. In the end, workers who believe they qualify for benefits, but have been denied them, need to make informed decisions on what steps to take next. What they should not do is lose hope. A denial is not the end of the story; the worker can appeal the denial if necessary.

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