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Delay Of Claims In California Workers’ Compensation

If you have been injured while on the job in California, you are entitled to workers’ compensation.  California law requires your employer to carry workers’ compensation insurance to cover your injuries, your medical bills, your lost wages, and other expenses incurred as a result of a work-related injury.  When you file your claim for workers’ comp, you have the right to expect a fast turnaround so you can start receiving medical care without fear of going bankrupt from medical expenses while your claim is pending.

Insurance companies, unfortunately, are not always willing to start paying what they owe as quickly as we would expect, given their obligations.  Your employer or their claims adjuster may send you a “Notice of Delay in Determining Liability for Workers’ Compensation Benefits,” declaring that the company plans to investigate your claim further before officially authorizing approval or denial.  These delays can be issued in good faith, should the claims adjuster have reason to doubt whether a claim is valid or questioning the amount they owe, but employers and insurance companies are just as likely to delay paying simply to protect their bottom line.

If your workers’ compensation claim has been delayed or denied, you need a qualified, dedicated, and aggressive workers’ compensation lawyer on your team to ensure that you are paid every penny you are owed and that your coverage starts as soon as possible.  At Invictus Law P.C., our board-certified specialist in California Workers’ Compensation Law knows the law and, just as important, knows how insurance companies and their lawyers think.  We will fight to ensure that you receive the maximum coverage possible and that you start receiving your benefits in a timely manner.

Reasons Claims May be Delayed or Denied

Insurance companies are looking for any reason to avoid a big payout.  To be fair, workers’ compensation is a system that is vulnerable to fraudulent claims made by employees.  But that does not give insurance companies the right to gin up excuses for delaying your coverage.  Employers and their insurers will go through your claims with a fine-toothed comb to find a reason to delay or deny your claim.

Common reasons for delay or denial include the following:

  • The physician’s diagnosis was inaccurate
  • A preexisting injury or condition caused the injury
  • The injury was sustained outside of work
  • There is insufficient evidence the injury or illness was caused by working conditions
  • A medical professional determined the injury was not disabling
  • The worker delayed in reporting the injury or filing a claim
  • The worker delayed in seeking appropriate medical care

Claims Cannot Be Unjustly Delayed

California law requires employers and their insurance companies to decide a workers’ compensation claim within a certain amount of time after the claim is reported and filed.  Generally, workers must provide notice to their employer of an injury or illness within 30 days of the incident or of discovering the illness, and the employer must then provide the worker with a workers’ compensation claim form.  Once the worker returns the form to the employer, the employer’s insurance carrier then has 90 days within which to either accept or deny liability for the claim.

Many claims are accepted immediately, although the insurer may have reason to investigate your claim further, as discussed above.  While your claim is pending, however, you are entitled to benefits for medical care.  The cost of medical care will be covered up to $10,000 until your claim is either approved or denied.  If your claim is neither approved nor denied within the 90-day period, then California law presumes that the employer and their insurer have admitted liability for the claim.

If your employer or their insurance company delays a decision on your claim without justification and refuses to pay for your benefits in the meantime, they may be subject to a penalty under California law.  You may be able to collect an extra 10 percent on all late payments from the insurance company.

Call Invictus Law For Help With Delayed Workers’ Compensation Claims In Orange County And The Inland Empire

If you’ve been injured on the job in California and need help securing fast, complete workers’ compensation benefits, contact a talented, knowledgeable, and efficient Orange County workers’ compensation delay of claims lawyer at Invictus Law at 949-287-5711, serving Orange County and the Inland Empire with offices in Orange and Ontario.

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