What happens if my employer or insurer denies my workers’ comp claim?

A denial is not the end of your case — it is the beginning of a dispute process before the Workers’ Compensation Board. When an insurer denies your claim, they file a Form C-7 (Notice that Payment of Compensation is Stopped or Denied) with the WCB, stating the grounds for denial. Common grounds include: injury is not work-related, no accident occurred as reported, pre-existing condition caused the disability, or the claim was not filed on time.

After a C-7 is filed, the WCB assigns your case to a WCB Law Judge and schedules a hearing, typically within 30 to 60 days. Both sides submit medical evidence. Your treating doctor’s reports carry significant weight. The insurer will often rely on their IME doctor’s report to support the denial.

At the hearing, the WCB Judge hears both sides and can rule immediately or take the case under consideration. The standard of proof is preponderance of the evidence — more likely true than not. You do not need to prove your case beyond a reasonable doubt.

If the Judge rules in your favor, the insurer must start paying your benefits and back-pay any weeks that were wrongfully denied, plus interest in some circumstances. If the Judge rules against you, you can appeal to the WCB’s Full Board under WCB Rule 300.13.

Do not try to fight a denial alone. Insurance carriers are represented by experienced defense attorneys. Our team handles WCB hearings regularly and offers free consultations. No fee unless we win — so there is no financial risk to getting help.