How To Prove Your Injury Is Work-Related After Being Denied Compensation in California

 Posted on December 04, 2025 in Denied Claims and Appeals

If your California workers’ compensation claim was denied, it doesn’t mean your case is over. You still have the right to appeal and present stronger evidence that your injury is truly job-related. Our experienced Santa Clara County, CA workers’ compensation lawyers will help you gather the documentation and testimony needed to support your case.

Why Would a California Workers’ Comp Claim Be Denied?

Insurance companies come up with many reasons to deny claims. Sometimes they argue that your injury did not happen at work. In other cases, they might claim you missed a filing deadline or didn’t provide enough proof. In fact, under California Labor Code § 5400, employees must notify their employer of a workplace injury within 30 days. Otherwise, the claim might be rejected, unless there is an eligible exception.

Denials also occur when medical reports are incomplete, when an employer disputes the details, or when there are small errors in paperwork. Understanding why your claim was denied helps you target what needs to be corrected on appeal.

What Does "Work-Related" Really Mean Under California Law?

For an injury to qualify for workers’ compensation, it must happen while you are at work, doing your job, or otherwise be directly related to your job. This includes both sudden incidents, like falling at a job site, and conditions that develop over time, such as repetitive strain or back injuries. Some mental health claims are also covered if the stress was mainly caused by your job. However, injuries during your commute or outside your job responsibilities may not qualify unless specific exceptions apply.

What Evidence Can Help You Prove Your Work Injury Is Legitimate?

Evidence is the most important part of appealing a workers’ comp denial. Strong examples include:

• Medical records linking the injury to your job duties

• Witness statements from coworkers who saw the incident

• Workplace photos, videos, or surveillance footage

• Supervisor or employer reports confirming the event

• Pay stubs or schedules showing you were working when the injury occurred

Each piece of documentation helps strengthen your case. Your treating doctor’s report plays a key role. The law states that a physician must clearly explain how the injury is related to your employment. If the initial report is unclear, you can request a supplemental report or evaluation by another qualified medical professional.

How To Appeal a Denied Workers’ Comp Claim in California

If your claim was denied, you still have the power to fight back. You can appeal the decision through the Workers’ Compensation Appeals Board (WCAB), which reviews disputes between injured workers and insurance companies. The process starts with filing an Application for Adjudication of Claim to officially open your case. From there, you or your attorney can request a hearing by submitting a Declaration of Readiness to Proceed. This is your chance to tell your story, share new medical records, and present witnesses or other evidence that supports your claim.

A Qualified Medical Evaluator (QME) may also examine your case and give an independent opinion about whether your injury is truly work-related. Their report often carries significant weight in the outcome. Because appeals move on strict deadlines, you need to act quickly once you receive your denial notice.

Schedule a Free Consultation With Our Gilroy, CA Workers’ Compensation Attorneys

At Raul Martinez Injury Law Firm, our Santa Clara County, CA workers’ compensation lawyers have decades of combined experience in workers’ compensation law. We understand how to navigate complex claims and denials. If your claim was denied, contact our office today at 408-848-1113 to schedule a free consultation. Hablamos Español.