If a person files a workers’ compensation claim, it is likely because he or she was injured at work and requires compensation for medical bills, lost wages, and possibly rehabilitation costs. Workers who file need a response as fast as possible so they can stop worrying about the expense and focus their efforts on recovering. However, insurance companies sometimes send employees a “Notice of Delay in Determining Liability for Workers’ Compensation Benefits,” stating they need to investigate a claim further before approving or denying it.
A delay in a claim can be triggered for good faith reasons, but other companies may use delays to attempt dishonestly to evade financial responsibility for a workers’ injuries. For example, a simple and straightforward injury might be compensated immediately; however, other illnesses or injuries will take months or years of recovery. Workers’ compensation insurance companies will have to pay a massive chunk of money to compensate the worker for medical costs and his or her wages if he or she cannot work during recovery.
If an employer or insurance company has a good faith reason for the delay, they will be given 90 days after serving a claimant with a Notice of Delay to conduct an investigation. During this time, an employer must authorize all medical treatments for the injury during the delay period up to $10,000. If the employer doesn’t reject a claim within this 90 days, the claim is presumed to be accepted, and benefits must then be paid.
However, if an employer or insurance company unreasonably delays paying a claim, they are required to pay an additional 25% of the value of the delayed claim or $10,000 (whichever is less). Also, if a disability payment is late, an automatic 10% increase is applied to the amount without the need to determine if the delay was unreasonable.
If your employer or insurance company is delaying a claim in bad faith, don’t hesitate to contact our skilled Santa Ana workers’ compensation attorneys. Ufkes & Bright has been helping injured workers since 1964. Let us see what we can do to help you navigate through the worker’s compensation process.
Contact us at (714) 909-2609 or fill out our online form to schedule a free case consultation today.