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.
- ADJ16903801 · 2026-10-16 · Fresno District OfficeAOE/COEapplicant prevailed
Determinative passage · p.9Further, in Hinojosa, the Supreme Court explicitly held that the employee passengers were equally entitled to the required use exception outlined in Smith because all of the workers bear the burden and expense of providing the necessary vehicle for employment. (Hinojosa, supra, 8 Cal.3d at 162.) As a result, the commute differs from routine commute in that the manner in which the job was structured was dependent on use of vehicle to transport employees, as well as the essential trailer, throughout the workday. Because the job impliedly required use of a vehicle, the accident did arise out of and in the course of employment and is therefore compensable. Accordingly, we deny the Petitions for Reconsideration in Case Numbers ADJ16903801, ADJ16689751, ADJ16903295, ADJ16903722, ADJ16903753, ADJ16604010, ADJ16903824 and dismiss the Petition for Reconsideration in ADJ17493829.
The evidence showed that the nature of the work required employees to furnish their own transportation during the workday due to shifting work locations, which fits the required vehicle exception to the going and coming rule, making the injury compensable.
Official decision · page 9 → - ADJ21248340 · 2026-10-16 · Sacramento District OfficeAOE/COEapplicant prevailed
Determinative passage · p.1Defendant seeks reconsideration of the Findings and Order (F&O) issued by the workers’ compensation administrative law judge (WCJ) on July 21, 2026. The WCJ found, in relevant part, that while employed by defendant as a groundsman on June 25, 2025, applicant sustained injury arising out of and in the course of employment (AOE/COE) to his lower back and right leg. The WCJ deferred and reserved all other issues. Defendant, in essence, contends that the evidence does not support applicant’s credibility and the finding of injury AOE/COE. Defendant further contends it has subsequently received sub rosa video evidence that further places applicant’s credibility in question. We have received an Answer from applicant. The WCJ issued a Report and Recommendation on Petition for Reconsideration (Report) recommending that the Petition be denied. We have considered the allegations of defendant’s Petition and the Answer, and the contents of the WCJ’s Report. Based on our review of the record and for the reasons discussed below, as well as the reasons stated in the WCJ’s Report, we will deny reconsideration.
The WCJ and WCAB found applicant credible based on consistent testimony and medical evidence from QME Dr. Lum, supported by objective findings and corroborating medical records, establishing injury AOE/COE to lower back and right leg on June 25, 2025.
Official decision · page 1 → - ADJ18291836 · 2026-10-12 · Fresno District OfficeAOE/COEapplicant prevailed
Determinative passage · p.6First, in workers’ compensation proceedings, when a WCJ’s credibility determinations are based on substantial evidence, they are “entitled to great weight because of the [WCJ’s] ‘opportunity to observe the demeanor of the witnesses and weigh their statements in connection with their manner on the stand...’ [Citation.]” (Garza v. Workmen’s Comp. App. Bd. (1970) 3 Cal.3d 312, 318-319 [35 Cal.Comp.Cases 500]; also see Meiner v. Ford Motor Co. (1971) 17 Cal.App.3d 127, 140-141.) However, “the Appeals Board is entitled to reject the [WCJ’s] findings on credibility matters if substantial evidence supports contrary findings...” (Garza, supra, 3 Cal.3d at 318-319.) In this case, it appears that the WCJ’s negative assessment of applicant’s credibility may need to be rescinded as it does not appear to be based on substantial evidence, and there is substantial evidence to support a contrary finding.
The WCJ's negative credibility finding was challenged as unsupported by substantial evidence; applicant's testimony was unrebutted and unimpeached; the Appeals Board found substantial evidence to support a contrary finding and granted reconsideration for further review.
Official decision · page 6 → - ADJ19100202 · 2026-10-05 · San Luis Obispo District OfficeAOE/COEapplicant prevailed
Determinative passage · p.17Following our independent review of the record occasioned by applicant’s Petition, we are persuaded applicant has established the necessary evidence to trigger the blood-borne infectious disease presumption of section 3212.8 and that defendant has failed to controvert the presumption. Accordingly, we grant applicant’s Petition for Reconsideration, rescind the June 30, 2026 F&O, and substitute a new F&O that finds that applicant met her burden to show that the section 3212.8 blood-borne infectious disease presumption applies; that defendant failed to rebut the
The Appeals Board found that the JC virus is carried in human blood and causes a disease meeting the statutory definition of blood-borne infectious disease under Labor Code section 3212.8; the defendant failed to rebut the presumption; therefore, the presumption applies and the injury is compensable as arising out of and in the course of employment.
Official decision · page 17 →