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Strong Advocates For Proper Medical Benefits

Under California workers’ compensation, employees are entitled to necessary medical care for a work-related injury. Yet injured workers are routinely denied medical care by employers or tightfisted insurance companies.

The legal team at Koszdin, Fields, Sherry & Katz can step in if you are denied medical benefits. All of the firm’s partners are workers’ compensation specialists* who know how to hold employers and insurers to their obligations. We have successfully appealed to claim denials and adverse medical evaluations for clients throughout Southern California.

Denied medical benefits for a work-related injury?
Call today for a free consultation to assert your worker’s compensation rights. Based in Van Nuys, our law firm represents injured workers throughout Greater Los Angeles.

Can You Choose Your Own Doctor?

The workers’ compensation system is not always friendly to the injured worker. When you seek medical attention for a work-related injury or illness, you cannot necessarily choose your own doctor. You must treat with one of the designated physicians in the employer’s medical provider network (MPN).

Have You Been Denied The Medical Coverage You Need?

Our lawyers can intervene if there is any problem with your medical benefits:

  • Access to medical specialists
  • Authorization for a second opinion
  • Denial of coverage for MRI or other diagnostics
  • Denial of surgery or therapeutic treatment
  • Denial of coverage for medications or medical equipment
  • Denial of your injury claim (not work-related, not serious, etc.)

Our attorneys are well-versed in the workings of the Division of Workers’ Compensation (DWC) Medical Unit and the procedures for appealing adverse decisions.

What About Independent Review Of A Disputed Claim?

Disputed claims may be reviewed by a panel QME (qualified medical evaluator) that you choose from a list. These are physicians who are assigned by the Medical Unit to examine workers and issue medical reports. The QME’s utilization review (UR) is used to determine eligibility for medical benefits and whether proposed treatments are medically necessary.

It is extremely important to immediately contact a lawyer if you receive a request for a QME panel.

Sometimes the panel QMEs cannot provide an objective medical opinion. One option is for the attorney and claim administrator to choose an agreed medical evaluator (AME) to resolve the claim dispute. Under new rules in 2013, injured workers may also request an independent medical review (IMR) when a specific treatment is denied, delayed or modified by a utilization review (UR). This expedited process is handled by a third-party administrator who contracts with the state. Either side can appeal an IMR decision to the Workers’ Compensation Board of Appeals.

Is There A Deadline To Report Work Injuries In Van Nuys?

One of the main reasons why a person may not receive medical benefits after sustaining a work injury in Van Nuys is because the injury was not reported on time. Work injury reporting deadlines can be confusing, even if you read the actual law in California. There are two deadlines that work injury victims need to be aware of.

The first of these deadlines revolves around reporting the injury to an employer. Under state law, all work injuries must be reported within 30 days. However, this 30-day timeframe can be confusing. In general, a work injury will need to be reported 30 days after it occurs, and this is not a problem for acute traumatic injuries. However, there are times when a person may not realize they have sustained an injury or illness as a result of workplace conditions. In these cases, the diagnosis may not come until sometime later. The law allows work injuries or illnesses to be reported within 30 days after a person receives a diagnosis.

The second of the deadlines mentioned has to do with filing the actual workers’ compensation claim. In general, an employer will begin the workers’ compensation claim process after they receive the initial injury report, particularly if the worker needs medical care. However, there are times when a worker may not need medical care because the full extent of their injuries was not realized right away.

If an employee realizes they do need medical care for a work injury or illness more than 30 days after the incident occurs, they can still file a workers’ compensation claim. In California, the law sets a one-year statute of limitations for work injury claims. This means that workers have one year from the date the injury occurred to file the actual claim, so long as they initially reported the injury or illness within 30 days to their employer.

What Are Other Reasons These Claims Are Denied?

Aside from denials based on not reporting the injury on time, there are various other reasons why Van Nuys medical benefits may be denied. Some of these reasons include:

  • The injury did not happen at work – It is not uncommon for an employer to try to blame their employee’s injury on an incident that took place outside of the workplace. This can be refuted by providing evidence of the injury occurring at work, which can include a photo or video surveillance or eyewitness statements.
  • Drugs and alcohol – Drug and alcohol impairment is often a disqualifier for workers’ compensation medical benefits.
  • Negligent behavior – Even though the workers’ compensation system is supposed to be no-fault, meaning it should not matter who caused the injury, the reality is that grossly negligent behavior on the part of the employee could disqualify them from receiving medical benefits.
  • Pre-existing conditions – Injuries or illnesses that an employee sustained before their employment began will not be covered under workers’ compensation. However, if the workplace exasperated or aggravated pre-existing injuries or illnesses, they should receive coverage.
  • You never saw a doctor – It is crucial for any work injury victim to see a doctor as soon as possible. If a work injury victim does not receive medical care, it is unlikely that they will receive medical benefits.

Contact Us For Skilled Legal Counsel

It is important to contact an attorney early in the claims process to ensure that you get the quality medical care you need, or to file your appeals in a proper and timely fashion. For a free consultation with our Van Nuys medical benefits attorneys, call 818-812-5639 or (toll free) 800-747-3447 or contact us online. You pay no fees unless we win your case.

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*Certified by The State Bar of California Board of Legal Specialization as specialists in workers’ compensation law

Any person who makes or causes to be made knowingly false or fraudulent material statements or material representation for the purpose of obtaining or denying workers’ compensation benefits or payment is guilty of a felony. Toda aquella persona que sablendo tapa o causa que se produzca cual quier falsas o fraudulentas alegaciones o representación de trabajadores es culpable de un crimen mayor.