Why Is My Workers’ Compensation Check Late?
When you are injured at work and cannot earn your normal wages, workers’ compensation benefits can be essential for paying your mortgage, rent, utilities, groceries, and other everyday expenses. So when your workers’ compensation check is late, the delay can create serious financial problems.
In California, workers’ compensation insurance carriers and claims administrators are required to follow specific rules governing when disability payments must be issued. A late payment may result from a legitimate dispute or investigation, but it may also be an improper delay that entitles you to additional compensation.
Invictus Law, P.C. represents injured workers throughout Orange County and the Inland Empire, protecting their rights to California workers’ compensation and helping them get the medical treatment and benefits they are entitled to under the law. Our experienced workers’ comp attorneys can help determine whether a delayed workers’ compensation payment is simply part of the claims process or a violation of your rights.
When Should California Workers’ Compensation Payments Arrive?
Temporary disability benefits are designed to partially replace wages when a work injury prevents you from performing your usual job while you recover. In general, temporary disability payments are made every two weeks. Temporary disability benefits generally equal two-thirds of the wages you lose, subject to the applicable maximum weekly benefit.
The first payment is subject to a separate deadline. California rules generally require the first temporary disability payment to be made no later than 14 days after the employer knows about both the injury and the resulting disability, unless liability for the injury is denied earlier.
That does not mean every injured worker receives a check exactly 14 days after reporting an injury. There are circumstances in which the claims administrator may need additional time to determine whether benefits are owed. However, the claims administrator must notify the worker when a temporary disability payment will be delayed and explain the reason for the delay.
Why Is My Workers’ Compensation Check Late?
There are several possible reasons a workers’ compensation check might not arrive when expected. Some involve legitimate issues that must be resolved before the amount or entitlement to benefits can be determined.
For example, the insurance company could still be investigating whether the injury is covered by workers’ compensation. The claims administrator may be reviewing medical records, employment information, wage records, or reports concerning how the injury occurred. If the claim itself is disputed, temporary disability payments may be delayed while the insurer investigates.
Medical information can also cause payment delays. Your doctor might not have provided updated work restrictions, or the claims administrator may be waiting for a report addressing whether you remain unable to work. A disagreement about your medical condition can affect whether you qualify for continuing temporary disability benefits.
There can also be administrative problems. A check may be sent to an old address, a payment may be processed incorrectly, or information needed to calculate the benefit may be missing. These issues do not necessarily mean the insurance company is acting improperly, but they should not simply be ignored.
The important question is not merely why the check is late. It is whether the claims administrator has complied with California’s requirements for handling the delay.
What If the Insurance Company Is Still Investigating My Claim?
California law allows a claims administrator to investigate a workers’ compensation claim before deciding whether benefits are owed. If the administrator cannot determine within the applicable period whether temporary disability benefits should be paid, the administrator is required to send a delay notice.
The notice should explain why the payment is being delayed, what additional information is needed, and when the claims administrator expects to make a decision. If the delay continues, additional notices may be required.
There is also an important 90-day rule. In most cases, if the claims administrator does not deny the claim within 90 days after the completed claim form is filed, the injury is presumed compensable, although that presumption can be rebutted under applicable law.
A delay notice does not mean you have lost your right to benefits. It means the claims administrator is taking additional time to make a determination. If the delay becomes excessive or the administrator fails to follow the required procedures, however, legal action may be appropriate.
What If My Workers’ Compensation Payments Stopped?
A more serious situation occurs when you have been receiving temporary disability checks regularly and the payments suddenly stop.
Sometimes payments stop because your doctor has released you to return to work, your condition has become permanent and stationary, or you have reached a statutory limit on temporary disability benefits. The claims administrator should provide appropriate notice explaining why benefits are changing or ending.
If your doctor has continued to certify that you cannot return to your regular job and you have not been told why your payments are ending, do not assume that the termination is correct.
California requires claims administrators to keep injured workers informed about temporary disability payments, including changes in payment amounts, delays, and termination of benefits.
A sudden interruption can be particularly serious because you may have arranged your household finances around receiving those checks. If benefits stop without a clear explanation, contact the claims administrator promptly and keep records of your communications.
Can I Receive a Penalty for a Late Workers’ Compensation Check?
Potentially, yes. California provides penalties for certain late workers’ compensation payments.
For temporary disability payments, if you filed a workers’ compensation claim form at least 14 days before a payment was due and the claims administrator sends the payment late, the administrator must add 10 percent to the late payment as a self-assessed increase. This rule is subject to exceptions, including certain situations involving an initial delay while the administrator determines whether temporary disability benefits are payable.
Permanent disability payments are also subject to payment deadlines. The claims administrator must begin permanent disability payments within 14 days after temporary disability payments end when permanent disability is payable, and permanent disability payments are issued every two weeks until the reasonable estimate of the amount due has been paid. Late payments can also trigger a 10 percent increase.
Another potential penalty exists when a delay is unreasonable. Under California Labor Code section 5814, the Workers’ Compensation Appeals Board may increase the amount of compensation that was unreasonably delayed or refused by up to 25 percent, subject to a maximum of $10,000. Whether that penalty applies and the amount awarded depend on the circumstances of the delay.
This distinction is important. A late payment does not automatically mean you will receive the maximum penalty available under the law. The circumstances surrounding the delay matter.
What Should I Do If My Workers’ Compensation Check Is Late?
Start by determining exactly what payment is late and when it was supposed to arrive. Keep copies of prior checks, payment notices, medical reports, correspondence from the insurance company, and any delay notices you receive.
You should also contact the claims administrator and ask for a specific explanation. Ask when the payment was issued, the amount of the payment, whether a delay notice was sent, and whether there is a problem with your claim or medical documentation.
Keep a written record of the conversation, including the date, the name of the person you spoke with, and what you were told. If the claims administrator says the payment was mailed, ask when it was mailed and whether a replacement can be issued if the check was lost.
If the problem is not resolved, you may need help enforcing your rights through the California workers’ compensation system. The Division of Workers’ Compensation provides Information and Assistance services to injured workers, and disputes over benefits can ultimately be brought before the Workers’ Compensation Appeals Board. California also provides procedures for seeking penalties when benefits have been unreasonably delayed.
Do I Need a Workers’ Compensation Lawyer for a Late Check?
Not every late check requires an attorney. An isolated mailing problem that is corrected quickly may not justify formal action.
The situation is different when payments are repeatedly late, benefits have stopped without a valid explanation, the insurance company claims you are no longer entitled to benefits, or the carrier refuses to pay benefits that appear to be due. In those circumstances, determining whether penalties are available and how to enforce payment can become complicated.
An attorney can review the payment history, medical records, notices from the claims administrator, and other evidence to determine whether the delay appears consistent with California workers’ compensation requirements. Legal representation can also be important when a late-payment dispute is connected to a larger disagreement about the extent of your injury, your ability to work, or your entitlement to continuing benefits.
Talk to Invictus Law, P.C. About Delayed Workers’ Compensation Payments in Southern California
A late workers’ compensation check can be more than an inconvenience. If you depend on disability benefits to replace lost wages, even a short delay can make it difficult to keep up with your financial obligations. When payments are repeatedly delayed or stopped without a satisfactory explanation, it is important to understand why and whether you are entitled to additional compensation.
Invictus Law, P.C. represents injured workers in Orange County and the Inland Empire, with offices in Orange and Ontario. If your workers’ compensation payments are late, delayed, or have suddenly stopped, contact Invictus Law, P.C. to discuss your situation and learn what options may be available.
