What Are the Reasons for Workers’ Compensation Claim Denial in California?

By Marc S. Wiesner

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Work Comp Benefits

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Last Modified on Feb 04, 2026

If you’re injured while on the job and are suddenly unable to work and provide for your family, what you receive from workers’ compensation is vital. For this reason, having your workers’ comp claim denied can have extreme consequences on your quality of life. You may wonder, what are the reasons for workers’ compensation claim denial in California? Knowing this is crucial to ensuring you submit a proper claim and get your benefits when you need them.

What Is Workers’ Compensation?

Workers’ compensation provides you with insurance if you’re injured while on the job. Workers’ comp is for employees in all industries, not just those with physically demanding jobs like construction workers or those who may be in dangerous situations like police officers.

It’s possible to be injured in any industry in a way that may make it hard or impossible for you to continue to work and provide for yourself and your loved ones.

Common reasons for filing a workers’ comp claim include:

• Coverage of medical care for diagnosing, treating, and recovering from job-related injuries or illnesses
• Treatment of repetitive stress injuries, like carpal tunnel
• Care for illness or allergic reaction to toxic substances at the work site
• Lost wages due to a workplace injury
• Temporary or permanent disability
• Funeral and burial expenses for a loved one who died on the job

10 Reasons Why Your Workers’ Comp Claim Might Be Denied in California

Each year, over 600,000 workers’ comp claims are filed in California, and a small percentage of those claims get denied.

Here are 10 reasons why your workers’ comp claim might be denied under California workers’ comp laws: 

1. Late reporting of injury. Under Section 5400 of the California Labor Code, an employee has up to 30 days to report a work-related injury or illness to their employer to receive workers’ comp benefits. If you don’t notify your employer within 30 days, your claim may be denied.
2. No proof the injury happened in the workplace: To be eligible for workers’ comp, your injury must have taken place while on the job. Not providing sufficient evidence of this can lead to an insurance company questioning your claim and denying it.
3. Inadequate medical evidence: A common reason for a workers’ comp denial is not having medical records that can clearly link your injury to your job. This can make it possible for your employer to say your injury was not work-related.
4. Witness statement issues: If coworkers who witnessed your at-work injury have conflicting statements or change their original story, that can cause the insurance company to potentially deny your claim.
5. Pre-existing condition: If your medical concern already existed before you started your job, such as low back pain, insurance may deny your claim. Comprehensive and accurate medical records can help you dispute the denial and show that the condition was either caused at work or aggravated by work duties.
6. Claim discrepancies or inaccurate information: If you file an official workers’ compensation claim form (DWC1) with the California Department of Industrial Relations, the information you provide must be complete and correct, or you risk your claim being denied.
7. Missed claim filing deadline: Under California Labor Code Section 5405, you have exactly one year from the date of the injury to file for workers’ comp. Filing later than that may lead to your claim being denied.
8. Injury due to negligence: An employer can dispute a workers’ comp claim if they believe the injury was due to negligence on the part of the injured employee, such as not following safety guidelines, fooling around, or being intoxicated.
9. Employment status issue: Under California workers’ comp laws, employers only need to provide workers’ compensation for employees defined through the ABC Test. Those considered independent contractors are normally not eligible for workers’ comp.
10. Suspicion of retaliation: If an employee files for workers’ comp after being fired, the insurer may consider that attempted retaliation against the employer and question the claim’s validity.

Choose Wiesner English, P.C.

When your workers’ compensation claim is denied, you need a lawyer who can identify the reason for the denial, gather the necessary evidence, and aggressively pursue the benefits you are entitled to.

For more than 20 years, Wiesner English, P.C. has helped hundreds of working Bay Area citizens properly file their workers’ comp claims and secure the benefits they need to recover from their workplace injuries. We can ensure your claim is properly filed without error the first time around, or assist with an appeal if your first claim was denied.

FAQs About Workers’ Compensation Claim Denial

What Happens if My Workers’ Comp Claim Is Denied in California?

If your workers’ comp claim is denied, you have the right to appeal that decision. Steps to appeal a denied claim include filing an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board and requesting a Mandatory Settlement Conference with a judge. Appealing a denied claim can be challenging, but our workers’ compensation attorney can help you through the process.

How Can I Strengthen My Workers’ Comp Claim?

Once you receive immediate medical attention for your injury, the most beneficial way to strengthen your workers’ comp claim is to hire a workers’ compensation lawyer who fully understands the California Labor Code. An attorney can also make sure you hit all necessary filing deadlines, collect all necessary evidence for your claim, and negotiate with insurance companies on your behalf.

What Happens if My Employer Tries to Retaliate for Filing a Workers’ Comp Claim?

If your employer tries to retaliate against you for filing a workers’ comp claim, contact a workers’ compensation attorney at our firm immediately to take action. Under Section 132a of the California Labor Code, it is against the law for an employer to discriminate or retaliate against employees for filing for workers’ compensation.

Do I Need to Hire an Attorney to File a Workers’ Compensation Claim in California?

Legally, you don’t need to hire a workers’ compensation lawyer to file a workers’ comp claim in California. However, California’s workers’ comp laws are complex with potential pitfalls that may lead to your claim being denied. Our workers’ comp attorneys have years of experience helping people successfully file their workers’ comp claims to receive benefits.

Hire a Workers’ Compensation Lawyer Today

Being injured on the job can be painful, stressful, and challenging to deal with, especially if you’re suddenly unable to work and provide for your family. Call Wiesner English, P.C. today to learn more about how our attorneys fight for the rights of injured workers in Northern California.