You’ve done everything right. You were injured on the job, reported it to your employer, sought medical care, and filed your workers’ compensation claim—only to receive a letter saying your claim has been denied. That moment can feel like a gut punch. Now, instead of focusing on your recovery, you're dealing with fear, frustration, and questions about how you'll cover medical bills or make ends meet.
You’re not alone—and a denial is not the end of the road.
Many workers in Ontario and throughout California face claim denials, even when their injuries are valid and their paperwork is in order. Insurance companies often look for technicalities, incomplete documentation, or other reasons to reject legitimate claims. The good news? You have legal rights, and you may still be entitled to benefits.
One of the biggest technical issues that lead to denial is failure to report the injury in time. In California, injured workers are required by law to report a workplace injury to their employer within 30 days of discovering the injury. If you wait too long, insurers may argue that the delay makes the injury suspicious or unrelated to work.
This is particularly risky in cases of cumulative trauma or repetitive stress injuries, where symptoms develop slowly. If your pain builds gradually and you don’t report it promptly, you may inadvertently hurt your chances of receiving benefits. That’s why early documentation and communication with your employer are crucial.
Another common reason for denial is the claim that your injury didn’t happen at work or wasn’t caused by your job duties. This is especially common for:
Insurance companies may argue that your injury happened off the clock, at home, or due to a non-work activity. In these cases, it takes strong medical evidence and a well-documented timeline to prove work-related causation.
Without the right medical reports, your claim is vulnerable. Insurance companies will often deny claims due to “insufficient medical evidence”—meaning the doctor didn’t provide enough information, or there’s no clear diagnosis linking your injury to your work.
Sometimes, workers see doctors outside of the employer’s Medical Provider Network (MPN), which can complicate or delay acceptance. Other times, medical records may be incomplete or not detailed enough to support the claim. This is why it’s vital to work with a legal team that ensures your records are properly prepared and submitted.
In some cases, the insurer may acknowledge the injury but deny that it’s serious enough to qualify for benefits. They may claim you can still work, don’t need treatment, or didn’t lose any income. This is common with:
Even so-called “minor” injuries can prevent you from doing your job safely or efficiently. If you’re in pain, unable to perform your normal duties, or your condition worsens without rest, you have every right to pursue benefits—and you may need medical and legal advocates to prove it.
Perhaps one of the most frustrating denials is when an insurer blames your current condition on a pre-existing injury. This happens frequently with back problems, joint pain, or repetitive use conditions. However, California law protects workers whose job duties aggravated or worsened a pre-existing condition.
The key is showing how your work directly contributed to the escalation of symptoms. With the right documentation and legal strategy, many workers have successfully overturned these types of denials.
When your claim is denied, the insurance company is required to send you a formal notice called a Notice of Denial. This document must include:
If you haven’t received this notice or the explanation is unclear, you have the right to request a clearer breakdown and clarification from the insurance adjuster—or better yet, through your legal representative.
California workers’ comp law allows you to appeal a denial by filing an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board (WCAB). This step essentially opens your case for review by a judge.
Once filed, your case will go through a process that may include:
The WCAB system is designed to give injured workers a fair opportunity to present their evidence and argue their case. However, it’s a legal process with strict rules, deadlines, and procedures—one that’s difficult to navigate alone.
You have the absolute right to hire an attorney to represent you at any point in the process, including before, during, or after a denial. In fact, having an experienced workers’ compensation attorney by your side significantly increases your chances of success.
A lawyer can:
At Tim Wright Law, we represent injured workers in Ontario and throughout Southern California who’ve had their valid claims wrongfully denied. We understand how insurance companies operate—and we know how to push back effectively.
Start by thoroughly reading the Notice of Denial you received from the insurance company. Understanding the basis for the denial is critical. It could be something fixable—like a missing form or misfiled report—or it could involve a more complex dispute over medical causation or injury severity.
Don’t try to navigate this process alone. A skilled workers’ compensation attorney can help you understand your options, evaluate the strength of your case, and begin the appeals process.
At Tim Wright Law, we regularly represent clients in Ontario and the Inland Empire who are fighting claim denials. We’ll take swift action to protect your rights and keep your case on track.
Start collecting all documents related to your injury and claim, including:
If any of these items are missing or incomplete, your attorney can help request and organize the necessary information.
To formally contest the denial, your attorney will help you file an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board (WCAB). This document opens a case within the California workers’ comp court system and makes your claim eligible for a hearing before a judge.
You typically must file this application within one year of the injury or denial notice—so acting quickly is essential.
Once your application is filed, your case will proceed through the appeals process, which may involve:
At this stage, having a knowledgeable attorney represent you can make the difference between a denied case and a successful outcome. Your lawyer will manage every step, advocate on your behalf, and work to secure the benefits you rightfully deserve.
If your workers’ compensation claim has been denied, don’t wait—your time to appeal is limited, and your benefits may be at stake. Acting quickly can make the difference between walking away empty-handed and getting the medical care and wage support you need to move forward.
At Tim Wright Law, we understand the urgency and frustration that comes with a denied claim. That’s why we offer free, no-obligation consultations to help you understand your rights and determine the best course of action. We’ll review your denial, identify the weaknesses in the insurance company’s case, and fight to get your benefits reinstated or approved.
You don’t have to go through this alone—and you don’t pay us a dime unless we win your case.
📍 Van Nuys Office – Workers’ Compensation Cases
16555 Sherman Way, Suite B2
Van Nuys, CA 91406
📞 Phone: (818) 428-1080
📧 Email: firm@timwrightlaw.com
🌐 Website: www.timwrightlaw.com
