A workers’ compensation claim is generally initiated by either the employer’s knowledge of your injury requiring medical attention or the filing of a workers’ compensation claim form (DWC-1). The start of the claim triggers the insurance carrier or administrator’s 90-day period to investigate your claim.
During this 90-day investigative period, where there appears to be potentially contested issues regarding coverage, the insurance carrier may indicate they have delayed your claim. This will typically be communicated to you while awaiting benefits such as indemnity to help while you are physically unable to work due to the incident.
A delay may also occur because the insurance carrier is waiting to obtain information that relates to your claim of injury. For instance, they may be waiting to speak to a witness to the event or they may be waiting to take your statement. I discussed witness/injury statements in my August blog for reference (http://www.geraldbrodylaw.com/blog/2016/8/31/i-just-filed-a-claim-what-is-all-of-this-paperwork-the-insurance-carrier-sent-me).
The carrier may also be waiting for receipt of medical records related to the injury. Oftentimes, when people are hurt they are seen by urgent care clinics, occupational medicine facilities or even emergency rooms. The insurance carrier will want to review these records to correlate the claim of injury and the findings of the physicians.
If you are treating for a workers’ compensation injury with your personal doctor, the claims administrator will likely want to review these records. Usually these records can substantiate your claim and help obtain the benefits you are entitled to. If you are unable to obtain these records for the claims administrator, they may require you to sign a release so they can have the particular facility provide the reports. I also discussed releases in August’s blog for reference (http://www.geraldbrodylaw.com/blog/2016/8/31/i-just-filed-a-claim-what-is-all-of-this-paperwork-the-insurance-carrier-sent-me).
During the delay phase, you have options. It is still part of the investigative period and therefore the employer/carrier is responsible for up to $10,000.00 of medical care costs related to your injury up until the time your claim is either accepted or denied.
There are other benefits that may be available to you not limited to state disability or Medi-Cal while your temporary disability indemnity or medical treatment is on delay. We are familiar with handling cases currently on delay and will discuss these options with you and help you decide if now is the right time to retain counsel to assist you with your claim.