Delayed Workers’ Compensation Claims: Fight for the Benefits You Deserve
Dealing with a workplace injury is challenging enough without the added stress of delayed workers’ compensation claims. California law protects employees by requiring employers and their insurance providers to act promptly when handling claims. Unfortunately, some insurers delay approvals or payments, leaving injured workers in financial and emotional turmoil. At Ochoa & Calderón, our dedicated workers’ compensation attorneys help employees fight back and secure the benefits they are entitled to receive.
Understanding Delayed Workers’ Compensation Claims
Workers’ compensation claims should follow a straightforward process. Once an employee files a claim, the insurance provider must investigate and decide within specific timeframes. Delays in this process can disrupt your recovery and create financial instability. Common reasons for delayed claims include administrative errors, incomplete paperwork, and disputes over the injury’s connection to the workplace.
If you face delays, you have the right to challenge the insurance provider and demand timely action. California law holds insurers accountable for unwarranted delays in both claim approvals and benefit payments.
Timeframes for Workers’ Compensation Claims in California
California sets strict deadlines for processing workers’ compensation claims:
- Claim Investigation: Insurance providers have 90 days to approve or deny a claim after receiving the completed form. If additional time is necessary, they must notify you and explain the delay.
- Medical Expenses: While the claim is under investigation, insurers must cover up to $10,000 in medical expenses related to the injury.
- Extended Deadlines: Insurers may request an additional 90 days to complete their investigation, but they cannot delay beyond 180 days without resolution.
Failure to meet these deadlines constitutes a violation, and injured workers can seek legal remedies to address the delays.
Penalties for Delayed Payments
Delayed payments can have severe consequences for injured workers. California law imposes penalties on insurers who fail to pay benefits on time:
- Late Disability Payments: Insurers must automatically pay a 10% penalty on overdue temporary or permanent disability benefits.
- Unreasonable Delays: If the delay is deemed unreasonable, insurers may face penalties of up to 25% of the overdue benefits. The worker must demonstrate that the delay lacked justification, and the penalty amount is determined by the court.
These penalties aim to discourage insurers from delaying payments and ensure that workers receive their entitled benefits promptly.
Proving an Unreasonable Delay
To hold an insurer accountable for an unreasonable delay, you must show that their actions were unjustified. Courts consider several factors when evaluating a delay, including:
- The length of the delay
- The impact on the injured worker
- Whether the delay was intentional or accidental
- Past instances of delayed payments by the insurer
- The worker’s conduct, such as providing timely documentation
Our experienced workers’ compensation lawyers can help you gather evidence, build a strong case, and hold insurers accountable for unnecessary delays.
Steps to Take if Your Workers’ Compensation Claim is Delayed
- Contact Your Employer: Notify your employer about the delay and request updates on your claim status.
- Provide All Required Documents: Ensure that you have submitted all necessary paperwork, including medical records and claim forms.
- Consult a Workers’ Compensation Attorney: Seek legal assistance to challenge the delay and secure your benefits.
- File a Complaint: Report the delay to the California Division of Workers’ Compensation (DWC) if your insurer fails to act within the legal timeframes.
FAQs About Delayed Workers’ Compensation Claims
What should I do if my claim is delayed?
Start by contacting your employer or insurance provider for updates. If the delay continues, consult with a workers’ compensation attorney to address the issue and protect your rights.
Can I receive additional compensation for delayed payments?
Yes, California law allows for penalties on late or unreasonably delayed payments, including a 10% automatic penalty and up to 25% for unreasonable delays.
How long does an insurer have to pay my benefits?
Insurers must issue payments promptly after approving a claim. Delays beyond the statutory timeframe may result in penalties.
What constitutes an unreasonable delay?
An unreasonable delay occurs when the insurer lacks justification for withholding or delaying payments. Courts evaluate factors like the delay’s length and impact on the worker to determine its reasonableness.
How can a lawyer help with a delayed claim?
A workers’ compensation lawyer can advocate on your behalf, negotiate with insurers, and file legal actions to ensure you receive the benefits you deserve without unnecessary delays.
Contact Ochoa & Calderón for Help With Delayed Workers’ Compensation Claims
Delayed claims can jeopardize your recovery and financial stability. At Ochoa & Calderón, our experienced workers’ compensation lawyers fight for your rights and help you secure the benefits you deserve. Call 951-901-4444 in Riverside or 844-401-0750 toll-free across Southern California. You can also contact us online for a free consultation. Learn more about related services, including workers’ compensation claims.
