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.
- ADJ7316783 · 2026-09-24 · Goleta District OfficeAOE/COEapplicant prevailed
Determinative passage · p.181. the applicant, while employed during the period of January 1, 2005 through October 31, 2009 as an office manager, occupational group number 214, at Santa Barbara, California by Ehlen, Spiess & Haight, Inc., sustained injury arising out of and in the course of employment to her left shoulder, neck, psyche and TMJ, right shoulder, and teeth. The issue of whether applicant sustained injury in the form of memory loss and headaches is deferred.
The Board found substantial evidence supporting industrial injury to these body parts and affirmed the WCJ's finding of injury.
Official decision · page 18 → - ADJ11687715 · 2026-09-24 · Sacramento District OfficeAOE/COEapplicant prevailed
Determinative passage · p.4The Court held that the uncontroverted evidence established exposure to smoke, the doctor stated that it was probable that the smoke inhaled contained carcinogens and it was reason that prolonged exposure could lead to lung cancer, need only establish that it was reasonably probable and was not required to produce exact type/amount of exposure, and that employment need only be a contributing cause. In the present matter, the issue of AOE/COE was addressed in the Findings of Fact. Applicant alleged that the decedent’s lung cancer and resulting death were caused by diesel exhaust exposure at work. The parties used Stuart Lonky, MD as the panel qualified medical evaluator. QME Lonky provided five reports and sat for four depositions. He reviewed extensive medical records, deposition transcripts from various employees at the City of Sacramento, including the Kristal the applicant, the injured worker’s spouse, and multiple medical articles on the relationship between diesel fumes and lung cancer. Throughout the reporting and deposition testimony, QME Lonky opined that there was industrial causation. QME Lonky’s
The Appeals Board agreed with the WCJ that the expert opinion of PQME Dr. Lonky constituted substantial medical evidence that the decedent's lung cancer and death were industrially caused by diesel exhaust exposure as a co-carcinogen, even with the decedent's smoking history, meeting the burden of proof by reasonable probability.
Official decision · page 4 → - ADJ16035139 · 2026-09-21 · Bakersfield District OfficeAOE/COEapplicant prevailed
Determinative passage · p.1Defendant seeks reconsideration of the Rulings and Orders Admitting Evidence, Findings of Fact and Order (FF&O) issued by the presiding workers’ compensation administrative law judge (PWCJ) on April 30, 2026, wherein it was found that decedent sustained an injury arising out of and in the course of his employment (AOE/COE) in the form of cardiac arrest resulting in his death on March 31, 2022, while employed by defendant as farm worker. Defendant contends that the finding of AOE/COE was not based on substantial medical evidence. 10F
The substantial medical evidence from PQME Dr. Simon, who opined with reasonable medical probability that the decedent's physical labor activities contributed to his cardiac arrest and death, was unrebutted and supported the finding of injury AOE/COE. Defendant's argument for medical certainty was rejected as the law requires only reasonable medical probability for causation.
Official decision · page 1 → - ADJ21161039 · 2026-09-04 · Santa Ana District OfficeAOE/COEapplicant prevailed
Determinative passage · p.4The medical opinions of Dr. Nikakhtar constitutes substantial medical evidence of injury AOE/COE and were unrefuted. The WCJ provided the following analysis in the Opinion on Decision (OOD): A defendant will not be liable for medical treatment where there is no industrial injury. (Kunz v. Patterson Floor Coverings (2002) 67 Cal.Comp.Cases 1588, 1593 (Appeals Board en banc).) Where a lien claimant litigates the issue of entitlement to payment for industrially related medical treatment, the lien claimant stands in the shoes of the injured worker and the lien claimant must establish industrial injury by a preponderance of evidence. (Kaiser Foundation Hospitals v. Workers' Comp. Appeals Bd. (Martin) (1985) Cal.3d 57, 67 [50 Cal.Comp.Cases 411]; Kunz, supra, 67 Cal.Comp.Cases at p. 1592.)”
The WCJ found substantial medical evidence of injury AOE/COE based on Dr. Nikakhtar's medical opinion, which was unrefuted and based on reasonable medical probability after an adequate examination and evaluation. Defendant failed to provide evidence to refute the medical history or opinion. The WCAB affirmed the WCJ's findings and admitted lien claimants' exhibits into evidence.
Official decision · page 4 →