Why is My Employer Delaying My Workers’ Compensation Claim?
When you’re injured at work, the last thing you need is an unexpected delay that keeps you from receiving income replacement benefits and medical care. The entire reason the workers’ comp system exists is to help workers get benefits without extra hurdles to jump while protecting companies from personal injury claims. Despite this, you’ll still see a number of California employers refuse or drag out claims, forcing employees to reach out to a workers’ compensation lawyer in the Inland Empire.
If your workplace is dragging their feet on your claim, you’re not alone. More importantly, you don’t have to face them alone. With the team at Moga Law Firm, you can fight for the benefits you are owed. Attorney Scot Thomas Moga is a zealous advocate for his clients, and he’s seen employers use every trick in the book to deny employees benefits they are legally entitled to. Call our workers’ compensation law firm at 909-931-2444 to schedule your complimentary consultation.
How the Process is Supposed to Work
When you’re injured at work, the process of getting benefits is meant to be quick and easy. The process begins when you fill out the employee section of the claim form. Make a copy for your own records and give the form to your employer. Your employer is then meant to fill out the employer section and return it to their workers’ compensation insurance company. They must also provide you with a copy of the form.
From there, the insurance company has 14 days to send you a letter notifying you of the status of your claim. If it is approved, you begin receiving benefit pay and they begin paying out your medical claims. If it is denied, you can appeal their decision.
Common Reasons for Delays
So if this process is generally so quick, why do so many employees have stories about employers dragging out their claims? Some of these reasons are legitimate and others are clearly fraudulent, and talking to a workers’ compensation attorney can help you figure out where your claim falls. Common reasons include:
- Still investigating the injury: Insurers may need more information before they make a decision on your claim. However, they only have 90 days to make that determination—otherwise, your injury is presumed to be work-related.
- Missing or incomplete paperwork: If your employer either doesn’t fill out their section of the form or claims that they never received your copy of the form, that can delay the process.
- Not sure if the injury is work-related: Issues arise when either your employer or their insurance company is unsure whether or not your injury is work-related. This may be due to eyewitness statements, a mismatch between the accident and the injuries you’ve reported, or an unwillingness to pay out the claim.
- MPN issues: Insurers can demand that you see a doctor within their Medical Provider Network. This can become a problem if their doctors have long wait times, because this delays your care and recovery.
- Retaliation and negligence: Employers may retaliate against employees or simply fail to fulfill their side of the workers’ comp agreement.
Red Flags to Watch Out For
If you notice any of these red flags, your employer may be delaying your claim in an effort to get out of paying for it:
- Employer tried to avoid giving you a claim form
- You haven’t heard from the insurance company within 14 days
- You aren’t getting any benefits while waiting for a decision
- Your employer is trying to force you to use sick days or vacation time instead of filing a claim
- Your employer tells you that your injury doesn’t qualify before they even submit your claim
Your Next Steps If Your Claim is Delayed
If your claim is being delayed, you have rights—but you have to protect them. Start by keeping copies of every form you submit and all correspondence you receive from your employer or their insurance company. When delays arise, reach out to both parties in writing to request updates. Seek medical treatment so you can begin the process of recovering. Should you continue to be ignored by your employer, you can file a claim with the Division of Workers’ Compensation. Finally, talking to a workers’ compensation attorney allows you to demand answers.
Discuss Your Case With a Workers’ Compensation Lawyer
The team at Moga Law Firm is here to help you tap into the benefits you’re entitled to as an employee. Call our workers’ compensation law firm at 909-931-2444 or connect with us online to get the process started.
Scot Thomas Moga, a dedicated attorney in San Bernardino & Riverside Counties who represents clients in the many types of personal injury, workers’ compensation and estate planning cases.
