Insurance Companies and their Duty to Investigate in Workers’ Compensation Cases

With respect to my Workers’ Compensation Claim, Does the Insurance Company handling my Claim have a duty to treat me fairly?

Yes. California law requires that Injured Workers be treated fairly. Regulation Section 10109 section (e) provides that “Insurers, self-insured employers and third-party administrators shall deal fairly and in good faith with all claimants” Not only does this section apply to the injured worker, it also applies to any dependent’s claims as well. Dependent’s claims may arise upon the injured worker’s death. In those circumstances, there can either be a death claim or an accrued benefits claim on a “live” claim. In other terms, any outstanding unpaid benefits owed up to the date of death.

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What Are California Workers’ Compensation Medical Appointments and Evaluations?

How Can They Damage a Worker’s Claim of Industrial Injury?

In California Workers’ Compensation Law, Injured Workers attend both medical treatment appointments and medical legal evaluations as part of their claims. While these appointments are intended to provide either treatment or assess aspects of Injured Worker’s claim, such as permanent disability, these examinations and evaluations can also inform Insurance Companies of information that cast doubt as to the validity or the severity of both, the Injured Worker’s claim and/or their entitlement to benefits. These items are frequently called “red flags.” Many doctors who contract with insurance companies will note these “red flags” within their reporting.

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What is Maximum Medical Improvement (MMI)?

Why is MMI Important to Your Workers’ Compensation Claim?

Maximum Medical Improvement is the term used within California Workers’ Compensation Law which applies to when one has recovered from their industrial injury.  Previously, in Workers’ Compensation Law, the term “Permanent and Stationary” was used. Continue reading

What are Industrial Disability Leave (IDL) Benefits?

Why are They Important?

IDL is a wage continuation program for some Government Workers. This can include people who work for the State of California, such as Government Agencies or Universities, as well as Teachers who work for Public School Districts. These employees must be members of the California Public Retirement System (CALPERS) or the State Teachers Retirement System (STRS.)

IDL is paid in lieu of the regular Workers’ Compensation Total Temporary Disability Benefits (TTD).

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