workers comp attorney explains if and how a workers compensation case can be delayed to conduct an investigationIf you have been injured at work in California, it is important to know your rights. Having a basic understanding of how a workers compensation claim is handled can be valuable knowledge in the event you get hurt at work and need to file a claim.

You may wonder whether it is possible for your workers’ compensation case to be delayed in order for your employer’s insurance company to conduct an investigation regarding your work-related injury. The short answer to this question is “yes.” However, there are certain rules the insurance company must follow if they choose to conduct such an investigation. Making sure you are aware of the rules will help you keep your workers’ compensation claim on the right track.

Reporting your Injury As Soon As Possible

It is important to report your injury to your employer as soon as possible. Once you report your injury, your employer is required to provide you with a Workers’ Compensation Claim Form to fill out. Be sure to fill out the form completely and accurately, and retain a copy of it, as it can be very important evidence for your case.

Your Employer Has Ninety Days to Make a Decision Regarding Your Claim

After you turn in your claim form to your employer, your employer’s workers’ compensation insurance company has three options for responding to the claim form: they may decide to accept your claim; reject your claim; or, they may choose to delay that decision in order to conduct an investigation. However, the insurance company has only 90 days to notify you of their decision to accept liability for your claim, or to deny your claim.

What Will Happen if Your Employer Decides to Delay the Decision on Your Claim

Again, if the workers’ compensation insurance company is unable to make an immediate decision to accept or reject your claim, the law allows them to delay making that final decision for a period of up to ninety days. This ninety-day delay period allows the insurance company to conduct an investigation regarding the merits of your claim. They must have a good-faith reason for conducting an investigation.

The insurance company may choose to conduct a detailed investigation regarding your work-related injury. The investigation may include interviewing co-workers who may have witnessed your injury. They may also order and review relevant medical records, which may include any records for treatment the day of the injury and afterward, as well as prior medical records for past treatment if it is to the same body part.

Medical Care During the Delay Period

Even if the insurance company does decide to delay the decision on your claim, you are still entitled to obtain medical care during the delay period. In fact, once you turn in your claim form, the insurance company must begin providing medical care within one working day, even if they decide to delay for an investigation. Generally, the insurance company is required to pay for medical care up to a maximum of $10,000, or until the time they decide to deny your claim, which ever happens first. Though your medical care will be paid for during this time, the insurance company is not required to pay you temporary disability benefits even if your treating doctor believes you cannot work due to your injury.

There may be certain limits on the type of medical care you are able to receive, even if your claim has since been accepted. According to California law, there is a limit of 24 chiropractic, physical therapy, and occupational health treatments you may receive during the life of your claim. However, exceptions may be made in some cases.

What Happens if Ninety Days Go by and I Haven’t Heard Back from the Insurance Company?

If the ninety-day delay period runs and you have not heard from the insurance company that your claim has been accepted or denied, then the law presumes your claim to be accepted.

Get Legal Help

Properly reporting a work injury does not guarantee that you will receive the benefits you are entitled to. Whenever a dispute arises about workers’ compensation benefits, the Santa Rosa workers’ compensation attorney at Kneisler & Schondel can give you the advice you need. Call us at (707) 542-5132 or ask a question by using our online contact form.