Generally, more complicated workers’ compensation cases take long to settle, but even a fairly simple one can drag on. There are a variety of causes that fuel the long way to settlement. Overworked insurance adjusters, physicians slow to providing medical reports, missing a required medical exam and other factors play a role in the timeline. However, some delays are built into the system to ensure that injured workers are medically stationary and permanent.
The process of determining the level of permanent disability is complicated and limited. All around, it requires a sophisticated analysis. Permanent disability benefits generally make up the bulk of an award or settlement. If there’s a dispute, the insurance company will send the injured worker to a qualified medical examination (QME) for a second opinion. If the (QME) physician disagrees with the worker’s primary treating physician, the case can come to standstill until the parties can negotiate an agreement or until a hearing occurs. Then, there’s the issue of a more complicated medical system. The system is designed with so many cost-cutting safeguards that impede doctors’ ability to provide care. The treatment must be reasonable to the specific injury. And if the doctor’s recommended treatment comes under question, the utilization review may come into play. This is the current system for second guessing the recommended treatment. If the process isn’t followed properly by the insurance company, delays can occur. Other reasons for delay include the need for further investigation, existence of prior injury or lack of witnesses.
The Appeal Process
While it’s always upsetting to receive a workers’ comp denial, it’s not the end of the road. You have the right to appeal at several levels. But the appeals’ process takes time. To file an initial appeal with the Workers Compensation Appeals Board (WCAB), you’ve got 20 days from notice to file a petition for consideration with the local district office according to California Labor Code Section 5903. With this petition, you’ve got to detail why the decision should be changed. You’ll also be required to include points of law in this petition. From there, the WCAB has 60 days to approve or deny your appeal. And if you have additional evidence, a new hearing will be scheduled. Even at the initial appeal’s stage, there’s time involved.
If you’re not pleased with the WCAB’s decision of your initial appeal, you can then appeal to the California state appellate court for a writ of review. However, what the appellate court can do is limited. It cannot reverse any findings of fact but only determine if the decision was reasonable. If you appeal for a writ of review, you’ve got to file for it within 45 days of the petition for reconsideration being denied.
How Claimants Can Avoid Delays
Injured workers can take steps to avoid delays in their workers’ comp case. Attending all medical appointments will avoid a delay or denial. Keep in mind that a strong worker’s comp case requires a lot of medical evidence. And if you fail to show up for hearings, medical appointments or your deposition, your case may be dismissed or benefits may be stopped. At your deposition and medical appointments, it’s important to tell the truth and not withhold any information. If you are caught lying, not only will this weaken your case, it will get you into trouble with fraud. You don’t want to do or say anything that will lessen your credibility or cause your case to come under greater scrutiny. Refusing to compromise will also drag things out. It often takes several appearances to get to trial and it can take months. There has to be a balance between what your case is worth and what the insurance carrier believes you deserve. Being prepared to compromise a fair settlement will get you to your goal quicker.
If you’re seeking to resolve your workers’ comp case or appeal a decision, it’s a wise choice to seek consultation with a good workers’ compensation attorney. A good workers’ comp attorney will not only help you understand and navigate the system but will help prevent delays whenever possible. Plus, this legal professional has the in-depth knowledge to challenge the insurance company and get you more in benefits.