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Delayed Workers’ Compensation Claims

Helping Injured Workers in Riverside Get the Benefits They Are Owed

California law requires employers to carry workers’ compensation insurance for employees. The law also requires workers’ comp insurance providers to pay out on legitimate claims of a workplace injury.  California law also sets strict time limits for evaluating workers’ comp claims and paying benefits that are due.  When a workers’ comp insurer fails to act in a timely manner and a workers’ benefits are delayed as a result, the worker has the right to bring a claim for the overdue benefits and possibly additional damages as well.

If your employer or workers’ comp insurance provider has delayed in investigating your claim or paying you the benefits you are owed, you have the right to seek legal action.  In Southern California, the Riverside workers’ compensation attorneys at Ochoa & Calderon will help you get the benefits you are owed, protect your rights, and hold your workers’ comp insurance provider responsible for any wrongful conduct.

Delayed Investigation

Workers’ comp insurance providers must resolve workers’ comp claims within a set period of time.  Once they receive a filled-out claim form from an injured worker, insurance providers are supposed to make an immediate approval or denial, but they have 90 days to either approve or deny the claim.  If they need additional time to make a final decision, they must notify you of the delay and the reasons for the delay.  Moreover, while the decision is pending, they must cover your medical expenses up to a total of $10,000.  They can only seek an additional 90 days to make their final decision.

If your decision has been delayed beyond the initial 90 days without explanation, if they continue to refuse you benefits while deciding, or if they try to withhold benefits after 180 days have passed, you have the right to hold them liable for your medical expenses and other damages.

Penalties for Delayed Payments

If you are entitled to workers’ compensation benefits and your insurance provider fails to make timely payments, you are entitled to compensation.  You are owed not only the past-due benefits but also additional penalties based on the type of claim.  Under California law, the amount of the penalty you are owed (on top of the benefits due) is based on the nature of the claim as well as the reason for the delay.  The penalty is paid in relation to the amount of benefits improperly withheld.

According to California’s Labor Code:

  • Late Disability Payments: Insurance providers must pay a 10 percent penalty on overdue payments for temporary or permanent disability benefits.  This penalty is, in fact, applied automatically for late payments.
  • Unreasonably Delayed Payments: If an insurance provider unreasonably delays paying workers compensation benefits, the provider is on the hook for a penalty of up to 25 percent of the missing payments.  The 25 percent penalty applies to any kind of delayed benefits, including temporary or permanent disability, medical treatments, death benefits, or any other payment that the insurance company was obligated to cover.  The insured party is responsible for demonstrating that the delay was unreasonable, and the amount of the penalty (up to 25 percent of the missing benefits) is up to the discretion of the court.

What is an “Unreasonable Delay?”

The seasoned workers’ comp attorneys at Ochoa & Calderon know how to get you the money you are owed.  If you are owed payments and your insurer is holding back, you have the right to get answers, and you have the right to your payments now.  In order to get additional damages based on a delay in payment, a worker must show that the delayed payment was “unreasonable.”

A court will evaluate whether a delay in payment was unreasonable by looking at several factors, including:

  • The amount of the overdue payment
  • The length of the delay
  • Whether the delay was accidental, and whether it was promptly corrected when discovered
  • Whether there has been a history of delayed payments or if instead it was a one-time mistake
  • Whether there is another statute mandating that the specific payments were owed within a certain amount of time
  • Whether there was a legitimate reason for the delay, including normal administrative matters
  • Whether the insurance provider committed institutional neglect, deliberately withholding resources that would have led to more prompt payments
  • How the delay affected the injured worker
  • Whether the worker’s own conduct contributed to the delay, such as failing to alert the company of the delay or failing to provide proper forms or other documentation

Riverside Workers’ Compensation Lawyers Ready to Fight for Your Rights

For help getting benefits after an on-the-job injury or workplace illness, call Ochoa & Calderon to discuss your case with a seasoned and effective California workers’ comp lawyer. Call 951-901-4444 in Riverside or 844-401-0750 toll-free throughout Southern California.

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