If you’re wondering what kind of medical benefits are included in a workers’ compensation claim,…
Although the vast majority of workers’ compensation claims are settled within weeks or even days, complex claims in which the employer’s insurance company contests the employee’s workers’ comp claim or disputes the severity of the employee’s injury are quite common in California.
Under California’s workers’ compensation system, injured workers are entitled to a quick resolution of their workers’ comp claim as long as their claim meets the definition of a “work-related injury” or “work-related illness.” “In cases involving complex or disputed matters, it is likely that the insurance company will delay paying out workers’ comp benefits,” warns our worker’s compensation attorney in Los Angeles at Koszdin, Fields, Sherry & Katz.
Luckily, California law imposes penalties for illegally delaying the payment of workers’ comp benefits, and provides protection for injured workers who sustain injuries on the job or whose injury or illness is caused or worsened by workplace conditions or hazards.
In cases where the nature, cause, and severity of the workplace injury or illness is not contested or disputed, the injured worker is usually able to obtain workers’ comp benefits immediately. If the injured worker misses three or more days of work due to an on-the-job injury or illness, he or she may be entitled to temporary disability benefits.
More often than not, eligible workers can start receiving temporary disability benefits about 14 days after the work-related injury or illness is reported. “However, if your employer questions the existence of your injury or has doubts about whether your injury is work-related, he or she may refuse to pay for medical treatment or provide temporary disability benefits,” warns our workers’ compensation lawyer in Los Angeles.
In that case, if you choose to seek medical care at your own expense, you may be entitled to seek reimbursement for the medical expenses. Moreover, if your lawyer can prove that your employer’s refusal to pay for or provide medical treatment was unreasonable, your employer will be facing a penalty of up to 25 percent of the cost of your medical treatment.
If you are eligible to receive temporary disability benefits, you can continue receiving them for up to 104 weeks or 2 years. In most cases, injured workers do not reach that threshold because they either return to work or transition to receiving permanent disability benefits.
Also, do keep in mind that it will take some time to determine and agree on the amount of workers’ compensation benefits. More often than not, employers and their insurance companies are trying to pay as little as possible, which is why the importance of being represented by a Los Angeles workers’ compensation lawyer cannot be overstated.
In addition to that, either the injured employee or his/her employer can disagree with how the treating physician evaluated the workplace injury. If that’s the case, either the injured worker or his/her employer can request the opinion of an independent doctor, called a Qualified Medical Examiner (QME).
If the parties fail to negotiate the amount of workers’ comp benefits even after a Qualified Medical Examiner offered his or her own independent opinion, the case will proceed to trial to be resolved by a judge at a hearing. As you may have guessed by now, hearings will further delay how soon you can receive your workers’ comp benefits.
Consult with our workers’ compensation lawyer in Los Angeles or elsewhere in California to discuss your particular situation if your claim has been delayed, ignored, or disputed. Contact Koszdin, Fields, Sherry & Katz to schedule a free consultation. Call our offices at 818-812-5639 or 800-747-3447.