It’s certainly disappointing to receive a letter saying that your workers’ compensation claim is being delayed, but it’s not the end of the world. You may be wondering whether the employer and their insurer are even allowed to do that. Indeed, they can decide to delay resolving your claim for up to 90 days from the day you informed your employer about the injury.
The letter should clearly state the reason for the delay and the date by which the decision will be made. The usual scenario is that the adjuster says they need more time to investigate the claim and reach a decision.
It’s very important to read the letter carefully to know exactly the grounds for the delay. Consider what aspects of your claim might cause suspicion in the adjuster. It would be best to act to dispel those suspicions – provide some additional information, provide the names of witnesses, refer to the time card, etc.
If you feel that your employer’s insurer and your employer are overly suspicious or the relationship is becoming confrontational, it’s best to turn to your workers’ compensation lawyer in Chula Vista CA. If you haven’t already retained the services of a lawyer, you should give it serious thought when your case is delayed or denied. A workers’ compensation lawyer in Chula Vista CA can deal with your claim professionally, build a case and even make your claim more credible in the eyes of the other party. They know what options are available and can provide you with guidance that is in your best interest.
$10,000 compensation entitlement
It’s logical that you will incur some medical bills to treat your injury until the claim is resolved. While your claim is delayed, you have the right to receive $10,000 for medical care and the delay letter should state that. However, this entitlement expires if the claim is denied in the end.
Investigating the injury
The most common reason for delaying a workers’ compensation claim is to ascertain whether the injury is really industrially related. Sometimes, the doctor’s report which the employee originally presented is not conclusive and doesn’t clearly state that the worker’s back injury, for example, was the result of heavy lifting in the workplace.
Statements from the worker’s colleagues can also impede the case. The injured worker may have been involved in a car accident some time before the injury and may have talked about it to his or her co-workers. If the employer’s insurer finds out this type of information it may raise a red flag automatically.
The way the hurt worker fills out the DWC-1 form can occasionally present problems. There are situations when the date of the injury is problematic. The DWC-1 form asks for the date of the injury, but it’s important to note that this doesn’t have to be a single day, it can be a period of time as well. If the employer or Human Resources personnel tell you that you must provide a specific date, know that’s not true.
A number of injuries are a result of a continuous trauma which extends over a period of time. If a worker with a cumulative injury provides a single date in the form (the day the employer was informed or the day the pain was unbearable and prevented the worker from performing the job duties), it may complicate the matters. The insurer could find out from the employer that that specific day was quite “light”, which raises suspicions regarding the employee’s injury.
Lack of witnesses is another cause for doubt when it comes to insurers who are practically trained to be suspicious. These situations require more investigation, which should be done “in good faith”, even though that doesn’t always seem to be.
Request for a QME panel
The delay letter may require the employee to be examined by a panel of qualified medical evaluators (QME). It’s very important that the worker take prompt action in choosing the panel of three doctors within the specified time period. Should the worker fail to choose the evaluators, the insurer will do that instead, and more likely than not, will choose the most conservative ones.
The doctors shouldn’t be picked randomly either. This is where an experienced workers’ compensation lawyer in Chula Vista CA would be an immense help. Lawyers specialized in this area often know some or all the doctors in their area, which can help choose the most amenable ones.
Accident & Work Injury Law Group can help you with your delayed case in Chula Vista CA
Accident & Work Injury Law Group is a team of experienced, ethical and aggressive attorneys specialized in workers’ compensation and personal injury. Our reputable attorneys work for a contingency fee, which means you only pay them when they win your case. You can also obtain a free no-obligation consultation regarding your case. Don’t be a victim of the system – protect your rights and call us today to get help!