In California, once a worker is injured at work and files a claim for benefits, the employer’s insurance has 14 days to acknowledge that the claim has been filed. At this point, the notice should tell you if your claim has been accepted, denied or delayed.
What Does This Mean?
First, don’t panic, the delay could be for a valid reason, and under California law, a WC insurance company is given time to investigate the claim. So, a delay might be legitimate, and these are some of the valid reasons there might be a delay:
- Investigation period: By law, the WC company is allowed an investigation period of 90 days to make a decision.
- Medical records: It takes time to get records gathered from all medical providers which is necessary to accept or deny a claim.
- Claims administrator: All records need to go to a claims administrator who will make the decision for the insurance company.
If you received an official letter saying the claim has been delayed, this just means that they are going to do thorough investigation before making a decision. But don’t worry, this is normal.
Options During Investigation Period
Don’t worry, they have to pay for all your medical treatment up to $10,000 during the time after the accident and up to the point they either “accept” or “deny” your claim. So if they have decided officially delay your claim, they will have to continue to pay your medical bills and can’t ask for the payments back later if the claim turned out to be correctly denied.
At this point, you can contact the WC company to inquire about the delay, or you can hire an attorney to help you with your claim. Sometimes it’s a great benefit to not have to worry about it and let a professional represent you.
90 Day Rule
If they decide to delay your claim, then they have 90 days from the date you filed the claim to make a decision on whether they accept or deny your claim. If they wait too long—even 91 days—then the claim is deemed accepted even if it could have been a deniable claim.
This rule is made to avoid unnecessary delays in making the decision, and the California Supreme Court has ruled in several cases that even a one-day delay past the 90 days can result in the claim being deemed accepted.
If the delay continues and is later considered unreasonable, then the WC company is subject to pay additional compensation to the injured employee. This penalty is 25 percent of the benefits paid or $10,000, whichever is less.
Dealing with WC Insurance Company
It can be frustrating working with your employer’s WC insurance company. Sometimes delays arise for a legitimate reason, and other times it’s a tactic by the company. Either way, it can cause you anxiety and uncertainty.
Many times, it’s best to get an attorney to assist you in your claims for compensation. This is a tough decision as many people don’t want to “make waves” or they simply don’t want to have to pay for an attorney. These are legitimate concerns, but most WC lawyers offer a free consultation so you can find out your rights and make an informed decision.
At the Law Office of Alice A. Strömbom, we don’t take a case unless it’s in the best interest of the client. If we don’t feel that we can help you get benefits, then we will let you know it’s best for us not to represent you.
During this free consultation, the injured worker can ask any questions and then can make a decision on whether to hire an attorney.
Also, hiring an attorney won’t get you in trouble with your employer as by law they have to allow you to be represented, and most employers understand that the WC insurance company may not play fair, and sometimes it takes a push to get them to do what’s right.
We believe strongly that you should receive medical treatment without having to deal with unnecessary difficulties. You don’t need to put up with insurance companies trying to refuse to provide you with medical treatment. A determined and persistent pursuit of your rights to receive medical treatment is our highest priority. During this difficult and stressful process, the Law office of Alice A. Strömbom will fight for you to get the treatment you deserve.
Contact a Sacramento Workers’ Compensation Attorney
In almost all cases when someone is injured on the job, the worker will get the best possible outcome by hiring an experienced Sacramento workers’ compensation lawyer.
Attorney Alice A. Strömbom focuses exclusively on Workers’ Compensation Law. She is very familiar with the tactics insurance companies use to avoid providing the medical treatment and disability benefits injured workers deserve, and has a recognized track record in combating such issues.