Workers’ Compensation Lawyer San Diego, CA

Watch Out for These Insurance Company Tactics in California Workers' Compensation Claims

Hand holding pen filling out a "Work Injury Claim Form"

A workers' compensation lawyer can help you fight back.

You were hurt on the job. You file a workers' compensation claim. The insurance company pays for your medical treatment, partial replacement of your lost income, and any other benefits you're entitled to receive under California law. Sounds simple, right?

Unfortunately, that is often not the reality. While workers' compensation insurance companies are supposed to assess claims fairly, make decisions within a reasonable amount of time, and pay the benefits that injured workers need and deserve, they are often more concerned with protecting their bottom line by finding any excuse to dispute, delay, or outright deny workers' compensation claims. Here are several of the most common insurance company tactics — and how a workers' compensation attorney can help you fight back.

Delaying a decision on your claim

If you're hurt on the job, you want a decision on your claim quickly. It's obviously important to know whether your medical expenses and other injury-related costs will be covered. Unfortunately, the insurance companies don't always see it that way. Sometimes, there are legitimate reasons to delay a claim; more often, however, they drag their feet in order to put pressure on the injured worker and protect their bottom line.

Under California law, insurance companies have 90 days to accept, deny, or delay a claim once officially notified of the claim, and if they do not make a decision within 90 days, the claim, as a matter of law, is presumed to be accepted. There are also certain requirements they need to meet during the 90-day delay period. If you have received a Notice of Delay or if it has been an unreasonable amount of time with no action on your claim, contact our law firm. We can deal with the insurance company on your behalf, get the process moving again, and pursue any penalties for unreasonable delays that may be available.

Asking for a recorded statement

The workers' comp insurance adjuster or case manager may ask you to provide a statement. They may imply that it's a necessary step to move your claim forward. This request may seem harmless; after all, you know your claim is legitimate, and you know what happened, so what's the harm in saying so? But in reality, injured workers often get tripped up and say something that will undermine their claim.

Here's what you need to know: you are never required to give a recorded statement to a workers' comp insurance company representative, and you shouldn't do it. If you are asked to give a statement, politely decline and call a lawyer.

More broadly, remember that the adjuster works for the insurance company, not you. No matter how friendly they may seem, at the end of the day, their job is to save their employer money. Trusting the adjuster is dangerous. Get legal advice. Your attorney's job is to protect your interests.

Disputing medical treatment and requiring an IMR

Workers' compensation is supposed to pay for the full cost of reasonable and necessary medical treatment for your work injury. That includes medication, medical devices, doctor's visits, physical therapy, surgery, hospital care, and any other treatment you may need. So, naturally, the insurance company will dispute what is "reasonable and necessary" in order to keep their costs down.

There are many tactics the insurance company can use to dispute whether your treatment is necessary, even after the doctor they picked has recommended that treatment.

As we've written before, the Independent Medical Review process is a prime example: you can request an anonymous doctor who reviews your records and decides whether to approve or deny your treatment, without ever examining you or even talking to you on the phone. It's no wonder that this so-called "Independent" doctor reaches a decision in the insurance company's favor the vast majority of the time.

Contact a workers' compensation lawyer today

There are many tactics the insurance companies use to pay injured workers as little as possible, and they have experience and resources on their side as they protect their own bottom line. Level the playing field with an experienced attorney who has a winning track record for California workers. If you've been hurt on the job and your workers' compensation claim is being delayed, disputed, or denied, contact McLaughlin & Sanchez today for a free consultation.

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