When they must send it
• No later than 14 days after the determination to deny was made.
The deadline this notice puts on you
If you disagree with the decision to deny your claim and wish to obtain a comprehensive medical evaluation, enclosed is a form that you must submit to the state Division of Workers’ Compensation (DWC) within 10 days to request a panel of three Qualified Medical Evaluators (QMEs). In addition, within 10 days after the DWC sends you a panel, you must choose a QME from the panel, make an appointment to be examined by the QME, and inform me of your choice and appointment time.
Quoted from the model notice below. Your letter should say the same — if it does not, that is worth asking about.
Rule text
California Labor Code § 5402 · 90 unspecified
Trigger: after the date the claim form is filed under Section 5401
(b) (1) If liability is not rejected within 90 days after the date the claim form is filed under Section 5401, the injury shall be presumed compensable under this division
8 CCR § 9812 · 10 unspecified
Trigger: to request a panel of three Qualified Medical Evaluators (QMEs)
The notice shall contain the following statement (with the phrase “ 10 days ” in bold font as shown): “If you disagree with the decision to deny your claim and wish to obtain a comprehensive medical evaluation, enclosed is a form that you must submit to the state Division of Workers' Compensation (DWC) within 10 days to request a panel of three Qualified Medical Evaluators (QMEs)
Quoted from the statute, marked computed. The deadline table is a draft extraction — read the official code if the two disagree.
The rule behind it
8 CCR §9812(i)
The official model notice
BENEFIT NOTICE INSTRUCTION MANUAL Claims Administrator Name Address City_State_Zip Telephone Number [include if available] Website address Date [Option] SENT VIA E-MAIL TO employee’s e- mail address Employee Employer: Address Date of Injury: City_State_Zip Claim Number: NOTICE REGARDING DENIAL OF WORKERS’ COMPENSATION BENEFIT CLAIMS ADMINISTRATOR NAME is handling your workers' compensation claim on behalf of EMPLOYER NAME. This notice is to advise you of the status of disability benefits for your workers' compensation injury on the date shown above. Select 1 or 2: (1) FULL DENIAL: After careful consideration of all available information, we are denying liability for your claim of injury. Workers’ compensation benefits are being denied because EXPLANATION FOR DENIAL. (If denial is based on a medical report, insert the following): A copy of the report is attached to this notice. (2) PARTIAL DENIAL: After careful consideration of all available information, we are accepting liability only for your claim of injury to LIST ACCEPTED BODY PART(S). Liability …
Published by the Division of Workers’ Compensation in the Benefit Notice Instruction Manual. Excerpt — read the full manual at the source. p.62.
Source · dir.ca.gov →When this went wrong
Decisions of the Workers’ Compensation Appeals Board on this subject. Each quotes the passage it turned on and links to the official PDF.
- ADJ18656111 · 2026-06-26 · Bakersfield District OfficeAOE/COEdefendant prevailed
Determinative passage · p.1Defendant seeks reconsideration of the Findings of Fact issued on March 3, 2026, wherein the workers' compensation administrative law judge ("WCJ") found that defendant did not prove that decedent's death was proximately caused by intoxication. Defendant asserts that the WCJ erred because the evidence supports the opinion of the Qualified Medical Examiner ("QME") that intoxication was a proximate or substantial cause of the injury.
The Appeals Board agreed with the WCJ that defendant did not prove by a preponderance of the evidence that decedent's intoxication was a proximate or substantial cause of the injury, due to lack of concrete evidence and reliance on speculative assumptions in the QME report.
Official decision · page 1 → - ADJ18031412 · 2026-06-26 · San Diego District OfficeAOE/COEdefendant prevailed
Determinative passage · p.1Lien claimant Medland Medical seeks reconsideration of the Findings and Order issued by the workers' compensation administrative law judge (WCJ) on April 6, 2026. Therein, the WCJ found that, while employed as a Machine Operator/Packer, applicant claims to have sustained injury arising out of and occurring in the course of employment (AOE/COE) to her bilateral arms, bilateral hands, back, bilateral hips, and bilateral legs. The WCJ further found that the case in chief settled via Compromise and Release with an Order Approving issuing October 14, 2025; that lien claimant did not meet the burden of proof on the injury AOE/COE, such that the lien is disallowed in its entirety. Based on these findings, the WCJ ordered that lien claimant's lien be disallowed in its entirety.
The lien claimant failed to meet the burden of proof by a preponderance of the evidence to establish injury AOE/COE based on the medical record and evidentiary record submitted. The ultimate conclusion of industrial causation was deferred to the Trier of Fact, and the WCJ found no sufficient evidence to support the lien claimant's claim.
Official decision · page 1 → - ADJ13582881 · 2026-06-26 · Long Beach District OfficeAOE/COEapplicant prevailed
Determinative passage · p.1Defendant seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Findings and Award of March 16, 2026, wherein it was found that while employed as an assistant manager applicant sustained industrial injury in the form of a hernia and to the low back, causing the need for further medical treatment. Industrial injury to the hernia had been accepted by the defendant, but injury to the low back was contested. All other issues including date of injury, temporary disability, and permanent disability were deferred.
The Appeals Board found substantial evidence supporting industrial injury to the low back based on the entire medical record and credible applicant testimony, favoring the treating physician's opinions over the PQME Dr. Shah's contrary opinion.
Official decision · page 1 → - ADJ14972494 · 2026-06-23 · Van Nuys District OfficeAOE/COEapplicant prevailed
Determinative passage · p.1Defendant seeks reconsideration of the February 3, 2026 Findings of Fact, Award and Order (F&A) issued by the workers' compensation administrative law judge (WCJ), wherein the WCJ found that while employed by defendant as a chief negotiator for the nurses' union, from February 4, 2005 to July 13, 2021, applicant sustained injury arising out of and occurring in the course of employment to her "internal" and eyes/vision, and claimed injury to various parts.
The WCJ's finding of industrial injury to the eyes/vision is supported by substantial medical evidence including the ophthalmology QME Dr. Sami's opinion, the internal medicine AME Dr. Grodan's deferral to Dr. Sami, credible applicant testimony, and contemporaneous treating records. The Report on Reconsideration supplies the reasoning required under Labor Code section 5313, curing any deficiency in the original Opinion on Decision.
Official decision · page 1 →