A denied workers’ comp claim is one the claims administrator, the insurer or adjuster handling it, has decided is not covered. The Division of Workers’ Compensation (DWC) says a worker who gets that letter has the right to challenge it, and that there are deadlines for doing so.
That challenge is the work of a denied workers’ comp claim lawyer in Orange County. The case goes to the Workers’ Compensation Appeals Board (WCAB), where workers’ compensation judges decide disputes. The Law Office of Jesse Melendrez represents injured workers only, including workers whose claims were denied or left without a decision.
What does the 90-day rule mean for a delayed claim?
It means the claims administrator’s time to decide has a limit. If it does not reject liability within 90 days after the DWC-1 claim form is filed, the injury is presumed compensable, and only evidence found after those 90 days can overcome the presumption (Labor Code 5402(b)). Some public safety injuries listed in the statute use 75 days.
The claim is not on hold in the meantime. Within one working day after the claim form is filed, the employer must authorize treatment, up to $10,000, until the claim is accepted or rejected (Labor Code 5402(c)). Filing the claim form also pauses the one-year limit in Labor Code 5405 until the claim is denied or presumed compensable (Labor Code 5401(d)).
What deadlines apply to a denied or delayed claim?
The main deadlines run from the injury, the claim form and the last benefit provided.
| Deadline | What it covers | Source |
|---|---|---|
| 30 days | Written notice of the injury to the employer | Labor Code 5400 |
| 1 working day | Employer gives or mails the DWC-1 claim form after learning of the injury | Labor Code 5401(a); DWC Guidebook, ch. 2 |
| 1 working day | Employer authorizes treatment after the claim form is filed, up to $10,000 | Labor Code 5402(c) |
| 90 days | Claims administrator rejects liability, or the injury is presumed compensable | Labor Code 5402(b) |
| 1 year | Start proceedings, counted from the injury, the end of disability payments or the last treatment provided | Labor Code 5405 |
| 30 days | Priority conference after a declaration of readiness, when a represented worker’s dispute is whether the injury is work-related | Labor Code 5502(c) |
Sources: Labor Code 5400, 5401, 5402, 5405 and 5502 on leginfo.legislature.ca.gov, read October 8, 2026; DWC Injured Worker Guidebook, 7th edition (May 2024), chapter 2.
How does a denied claim get to a judge?
The worker files an Application for Adjudication of Claim (DWC-CA form 10232.1), which opens a case at the WCAB. It is filed in the county where the worker lives, where the injury happened or, for a represented worker, where the attorney’s main office is, unless the employer objects to that last choice (Labor Code 5501.5). The office assigns a case number that starts with ADJ (DWC).
A hearing is set only after a Declaration of Readiness to Proceed (DWC-CA form 10250.1) is filed (DWC I&A Guides 4 and 5). The usual first hearing is a mandatory settlement conference 10 to 30 days later, or a priority conference within 30 days when a represented worker’s dispute is whether the injury is work-related (Labor Code 5502(c), (d)). Discovery closes at the mandatory settlement conference, and if the case does not resolve there, the trial is to be held within 75 days of the declaration (Labor Code 5502(d)(1), (3)).
Orange County cases are heard at the Santa Ana district office, 2 MacArthur Place, Suite 600, and the Anaheim district office, 1065 North Link, Suite 170. The areas we serve page lists the office for each city.
Where does a QME fit in a denied claim?
A qualified medical evaluator (QME) comes in when the dispute is medical, such as whether work caused the injury. The DWC says that when there is a disagreement about whether a claim is covered, the worker may be evaluated by a QME.
With an attorney, either side may request a panel of three QMEs from the DWC once 10 days have passed after a written request for an evaluation, and each side may strike one name (Labor Code 4062.2). The two sides can instead agree on an agreed medical evaluator (AME). The employer pays for the evaluation (Labor Code 4064(a)), and the QME and AME page walks through the panel.
How does the firm work a denied claim?
The DWC describes an applicant’s attorney’s job as protecting the worker’s rights, planning a strategy, gathering information, tracking deadlines and representing the worker at hearings (DWC Guidebook, chapter 11). On a denied claim, it runs in this order:
- You receive the fee disclosure form at the first consultation and speak with a California-licensed attorney at the firm before signing it. The form names the district office where the case will be filed (Labor Code 4906(e), (g)).
- We read the denial letter for the reason it gives and collect the claim form, medical reports, wage records and claims file.
- We file the Application for Adjudication, or step into an open case. From then on, the claims administrator deals with the office on the important matters.
- We request the QME panel or negotiate an AME, explain how a deposition works and attend it with you.
- We file the declaration of readiness when the case is ready and appear at the conferences and the trial.
A denial can also hold up temporary disability and other benefits.
There is no upfront cost. Attorney fees in a California workers’ compensation case are set and approved by a workers’ compensation judge and are paid out of the benefits recovered. Whether a particular denial can be challenged depends on its facts, and that is what the first conversation is for.
