Many Injured Workers have their workers’ compensation claims delayed.
This article will discuss why claims are delayed and what Insurance Company activities occur during the delay period.
Why Are Claims Delayed?
Insurance Companies delay claims in order to verify that there is a legitimate claim. Per the Labor Code, they are afforded this opportunity to investigate.
As part of their investigation, Insurance Companies will investigate the following matters.
Coverage: Insurance Companies need to verify that they actually insure the Employer for the date of the injury.
Employment Verification: Insurance Companies need to verify the Injured Worker actually worked for the Insured Employer.
Date of Injury: Insurance Companies need to verify the date of injury.
Employer Injury Knowledge: Insurance Companies need to know if the Employer knows about the work injury. They need to know the details how the injury happened, whether there were witnesses, and whether it was reported to management.
Medical Verification: Insurance Companies will seek to obtain the medical reporting from the Industrial Clinic or the Medical Provider who treated the worker.
Statements: Insurance Companies may seek the use of an investigator to take statements of the injured worker, other employees of the company, or witnesses, to verify the injury. Investigations can be done by Attorney who may take depositions.
Records: Insurance Companies may seek records from prior employers, insurance companies or medical providers
Qualified Medical Evaluation: An Insurance Company may seek a Panel Evaluator from the State of California to obtain a medical opinion on causation. .
What is the Authority for Delaying a Workers’ Compensation Claim?
Labor Code Section 5402(b) provides for a 90 day period upon which Insurance Companies have to deny a claim. Thus, there is a 90 day period to delay the claim and investigate. This 90 days is from the knowledge of the claim.
The date of knowledge is per LC 5402(a) which provides that “ [k]nowledge of an injury, obtained from any source, on the part of an employer, his or her managing agent, superintendent, foreman, or other person in authority, or knowledge of the assertion of a claim of injury sufficient to afford opportunity to the employer to make an investigation into the facts, is equivalent to service under Section 5400.” Thus, employer knowledge can trigger the start of the insurance company’s delay period
What If I Need Advice?
If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.