Knowing what to do after a denial letter matters more than almost anything else in your claim right now. A denial is not the end. In most cases, it is the start of a formal dispute process that your state built for exactly this moment. Insurers deny claims for many reasons, and plenty of those reasons are fixable paperwork problems, not proof that you were never hurt.
However, denials come with hard deadlines. Miss one, and you can lose benefits you were otherwise owed. This guide walks through what to do after a denial letter in plain English: how to read the letter, what deadline applies in your state, how to gather proof, and where to file. You are hurt and worried about money. Take this one step at a time.
First, read the letter and find out exactly why you were denied
Your denial letter must say why. Common reasons include a late report to your employer, a dispute over whether the injury happened at work, a gap between the injury date and your first doctor visit, or a pre-existing condition argument. Some denials are partial. For example, the insurer may accept your back injury but deny treatment for your shoulder. Read carefully to see whether everything was denied or only part.
Write down the date printed on the letter and the date you received it. Appeal clocks usually run from one of those dates. Keep the envelope. Then request your full claim file from the insurance adjuster in writing. You are typically entitled to the medical reports and statements they relied on. Seeing their evidence is a core part of what to do after a denial letter, because you cannot answer an argument you have not read.
Also check whether you actually received a denial or a delay notice. These are different. In California, for example, Labor Code section 5402(b) says that if the employer does not reject your claim within 90 days of the DWC-1 filing, the injury is generally presumed compensable. A delay letter is not a final “no.”
The deadlines: what to do after a denial letter in your state
Deadlines are the part people lose claims on. They vary widely by state, and they are strict. Typically you must file a formal document with the state board, not just call the adjuster. Arguing with the insurance company does not stop the clock. File first, negotiate second.
| State | Where a denied worker files | General deadline | 2026 max weekly benefit |
|---|---|---|---|
| California | Application for Adjudication of Claim (WCAB) | Generally 1 year from date of injury | $1,764.11 (TTD) |
| Florida | Petition for Benefits (OJCC) | Generally 2 years from the accident | $1,358 |
| New York | Appeal a Law Judge decision to the WCB panel | 30 days from the filing of the decision | $1,281.50 (injuries 7/1/26–6/30/27) |
| Pennsylvania | Claim Petition; appeal to Commonwealth Court | 30 days from the Appeal Board decision | $1,394.00 |
| Texas | Request a Benefit Review Conference through DWC | Exchange records 14 days before the BRC | Confirm current figure with DWC |
These maximum weekly amounts change every single year, usually with the statewide average weekly wage. Pennsylvania’s 2026 figure rose 3.5 percent, for instance. Always confirm the current number with your state board before relying on it. Most states pay wage replacement at about two-thirds of your average weekly wage, which is your typical pre-injury pay, capped at the state maximum.
What to do after a denial letter: your practical next steps
Start with the filing. Get the correct form from your state board’s website and file it before the deadline, even if your evidence is not perfect yet. Filing preserves your rights. You can add medical records later. In Texas, you can begin by calling DWC Customer Service at 800-252-7031 to request a benefit review conference, and the Office of Injured Employee Counsel offers injured workers free help with their claims.
Next, fix the evidence gap. Ask your treating doctor to write a short causation letter that plainly connects your injury to your job duties. That one document resolves many denials. Gather your incident report, texts to your supervisor, coworker statements, pay stubs for the 52 weeks before the injury, and every medical record. Keep a simple daily log of pain, missed work, and mileage to appointments.
Keep treating, even while denied. Use your health insurance if you must, and tell providers the injury was work-related so billing can be sorted out later.
If you win, unpaid medical is usually recoverable. As a result of ongoing treatment, you also build the record that supports temporary total disability (TTD, wage checks while you cannot work) and later permanent partial disability (PPD, payment for lasting damage). PPD is set after maximum medical improvement (MMI), the point your doctor says you are as recovered as you will get, using an impairment rating — a percentage of lasting loss that many states convert into a set number of weeks of pay.
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Finally, get free or low-cost help. Many state boards have an ombudsman or injured-worker advocate at no charge. Any settlement figure you see online is illustrative only; every case is different, and a compromise and release (a lump sum that usually closes your claim for good) has real trade-offs. Confirm your options with your state board and a licensed attorney.
Frequently Asked Questions
Does a denial mean my claim is over?
No. In most cases, a denial simply moves your claim into your state’s dispute process. Many claimants win benefits after an appeal, especially when the denial was based on missing paperwork or a doctor’s unclear note.
Can I get paid while I appeal?
Typically not from the workers’ comp insurer while the denial stands. However, you may be able to use short-term disability, state disability, unemployment, or your health plan in the meantime. Some states also allow penalties for unreasonable delay — California, for example, permits up to 25 percent of benefits owed under Labor Code 5814.
How long does the appeal take?
It varies a lot by state and by how backed up your board is. Informal conferences may happen within weeks, while a full hearing and written decision often takes several months. For example, Texas starts with an informal benefit review conference before moving to a contested case hearing.
Not Sure Where You Stand?
If your claim was denied, your benefits stopped, or a settlement offer feels low, it is worth having a workers’ comp attorney look at it. Most give a free consultation and work on contingency — so there is usually nothing upfront.
Advertising — not a referral, endorsement, or legal advice.
Sources & How to Verify
This guide is built from official government and industry sources. Workers’ comp figures, deadlines, and state rules change every year, so always confirm the exact figure with your state board or a licensed attorney:
- Your state workers’ compensation board / division: the first and most authoritative source for your state’s caps, deadlines, and rules.
- U.S. Department of Labor: dol.gov — the directory of state workers’ comp officials.
- NCCI: ncci.com — workers’ comp rating and benefit data.
- Social Security Administration: ssa.gov — SSDI offset and benefit-cap data.
- Insurance Information Institute: iii.org — neutral coverage and claims data.
Verified August 2026. State maximum weekly benefits change every year — if you spot anything outdated, please contact us.
Related Guides
- The Complete Guide to Workers’ Comp Settlements
- Workers’ Comp Settlements by State
- Workers’ Comp Benefits Explained (TTD, PPD, MMI)
- Your Rights at Work — Common Scenarios
- Plain-English Workers’ Comp Glossary
Disclaimer. This page is for general information only and is not legal, medical, or financial advice, and it does not create an attorney-client relationship. Workers Comp Explained is an independent educational resource, not a law firm, insurer, or medical provider. Benefit caps, deadlines, and rules vary by state and change every year, and any settlement figure is an illustration, not a prediction. For your situation, confirm the exact figure and any deadline with your state workers’ compensation board and a licensed attorney before you act.