Denied Workers’ Comp Claim in California? Here’s What to Do Next
A denied workers’ compensation claim is frustrating, confusing, and deeply upsetting — especially when you know your injury happened at work and no one is listening.
Don’t panic.
At Lee Partners Law, we’re former defense attorneys who now fight for injured workers across California. We’ve seen every insurance company tactic used to deny legitimate claims — and we know exactly how to beat them.
Here are the most common reasons workers’ comp claims are denied in California — and what you can do next.
1. Denied for “No Medical Evidence”
This is one of the most common — and absurd — reasons for denial. Insurance companies may claim there’s no medical proof of injury, even when you’ve gone to urgent care, your primary doctor, or even the ER.
Often, the real issue is that they simply never obtained your medical records — or your treating doctor didn’t initially connect the injury to work because you’re not a medical expert, and neither is your employer.
But Labor Code § 5402(c) is clear: once you file a claim, the insurance company must authorize up to $10,000 in medical treatment and schedule an evaluation within 30 days. When they fail to do this, and then deny your case based on lack of medical evidence, it may constitute bad faith.
✅ What to do: You have the right to request a Qualified Medical Evaluator (QME) in the specialty of your choice (e.g., orthopedics, psych, chiro). This doctor is neutral, paid for by the insurance company, and will conduct a full exam, review your records, and order diagnostics to objectively determine whether your injury is work-related. A QME is a vital tool in challenging the denials and critical to determining the value of your case.
2. Denied Due to Filing “Post-Termination”
Under Labor Code § 3600(a)(10), your claim may be denied if it was filed after you were laid off or terminated.
But as former defense attorneys, we know all the ways to defeat this:
If you reported your injury to a supervisor before termination — the defense doesn’t apply.
If you sought medical care before being let go — it doesn’t apply.
If you’re filing a cumulative trauma claim (e.g., back pain, stress, wrist injury from repetitive work), and a QME confirms you suffered the injury while employed, you can beat this defense under Labor Code § 5412.
This area of law is complex, but the short version is: don’t let post-termination scare tactics stop you. These denials are often beatable. We have decades of experience dealing with these denials and have tried and true strategies to beat them.
3. Denied for Filing “Too Late” (Statute of Limitations)
Claims examiners may argue you missed the one-year deadline to file a claim under Labor Code § 5405.
But this deadline has exceptions:
Your employer is legally required to notify you of your rights — and often fails to do so.
Cumulative trauma and latent injuries (like hypertension, cancer, or heart disease) may not become apparent for months or even years.
The clock doesn’t start until you knew or should have known your injury was work-related — a standard that often favors the injured worker.
✅ Even if you haven’t worked at the job for years, you may still have a valid claim.
Don’t Let an Insurance Denial Stop You
Workers’ comp insurance carriers routinely deny legitimate claims, hoping injured workers will give up. At Lee Partners Law, we make sure that doesn’t happen.
We’re David and Michael Lee — former defense attorneys turned dedicated advocates for injured workers. We know every denial tactic and every way to challenge them. Whether your case involves cumulative trauma, psychological stress, or a sudden injury, we’re ready to fight for you.
Contact Us Today for a Free Case Review
Even if your claim has been denied, it’s not the end of the road. Contact us to speak directly with an attorney who understands the system — and knows how to beat it.
📞 Call us or message us now to tell us what happened. We’re here to listen — and we’re ready to help.