Many states have either an official or unofficial rule that employers and insurance companies have 90 days to review a workers compensation claim. Rules vary by state. Fortunately, as Forbes reports here, California has one of the better 90-day rules when it comes to workers’ rights:
“Under California law, workers’ comp insurers must respond to your claim within 14 days of the time a work injury claim form is submitted. In some cases, employers will delay a decision on a claim. Employers must provide up to $10,000 in medical care during this delay period but don’t have to pay temporary wage loss benefits during this time period when the claim is delayed.
If employers delay a claim, they then have a period of 90 days in which they can review and respond to the claim. If more than 90 days have passed, then the claim is presumed to be accepted so your medical bills, possible TD benefits and other eligible costs related to the work injury should be covered.”
The State of California puts the onus on employers to respond to an employee’s claim within a reasonable timeframe. However, the injured worker needs to get the ball rolling by filling out the DWC 1 form. More details about the process can be found on the State of California workers’ compensation FAQ here.
The Department of Industrial Relations outlines next steps to take for different circumstances, such as a disagreement about your benefits. In that case, you may need to visit a Qualified Medical Examiner (QME) to act as an impartial medical expert for your case. You can read more about QMEs here.
In the event of a dispute, having an attorney on your side can be a huge help. In fact, one of the primary reasons Melissa Lyons became an attorney and started her own firm was because of the frustrating experience her mother had in the California workers’ compensation system. If all this seems daunting, contact us and let us know how we can help.