The law allows an insurance company to deny a claim for good cause, within 90 days of the claim form filing. So the question is, did the insurance company have good cause? Often they do not, which opens the door for us to have the case declared compensable under workers compensation law.
That is a medical question to be discussed with your doctor. We can help with choosing the appropriate doctor to return you to the fullest health possible.
The employer is always listed as a party to the claim. But unless the employer is self insured against work related injury, generally we are dealing with an insurance adjuster and/or a defense attorney hired by the insurance company.
Worker’s Compensation Law does not allow for compensation for “pain and suffering” the way a personal injury lawsuit does. The four benefits allowed for are:
Temporary disability payments – these are benefits paid to the injured worker while recovering from a work related injury during the time he or she is unable to work. The amount of the payment is dependent upon the income in the one year prior to the injury.
Medical treatment – a primary treating physician makes treatment recommendations which are then reviewed by the adjuster and either approved (certified) or denied. If treatment is denied, we can help with the appeals process to have the denial evaluated and perhaps overturned.
Permanent Disability – these are payments based upon the level of impairment from which an evaluating doctor does not expect recovery. The amount of compensation is dependent upon the level of impairment as determined by an evaluating doctor. That’s why it is imperative to choose a fair, thorough doctor who is well versed in the requirements of a writing a report which will withstand scrutiny in a court of law.
Supplemental Job Displacement Voucher – if your injury has caused you to be unable to return to your usual and customary occupation, and your employer does not offer you a modified or alternate position, then you are entitled to a voucher to be used for retraining purposes. The amount of the voucher is dependent upon the date of the injury and the level of permanent impairment.
The length of the legal case is dependent largely upon the medical needs of the injured worker. Legal matters cannot be completed until the injured worker has recovered to the fullest extent possible. If an injury requires surgery, or even multiple surgeries, then the legal matters cannot be completed until after a doctor has declared that the injuries have reached a plateau and are not expected to improve or worsen any time in the near future. This can take months or years.
We work on contingency. If we’re able to obtain monetary results for you, we request a percentage.
Legal status is not a bar to a injured worker’s rights to temporary disability, medical treatment or permanent disability benefits. Our office is fully Spanish/English bilingual and services all injured workers. If your language is other than Spanish or English, the insurance carrier is required to provide a certified interpreter in your primary language. We have the resources to locate such an interpreter for your medical appointments and all legal proceedings.