How Does The Workers’ Compensation 90-Day Rule Affect You?
In California, workers’ compensation insurance companies must respond to all workers’ comp claims within 90 days. If your claim isn’t denied within 90 days, it will be presumed accepted. Additionally, while the insurer makes its decision, they are responsible for paying your medical bills up to $10,000 – even if they end up denying your claim.
If it’s been more than 90 days and you have not received a decision (or payments) on your workers’ compensation claim, or if you’ve received a Notice of Delay, contact the Law Offices of Hinden & Breslavsky, APC. Our Los Angeles delayed workers’ compensation claim lawyers can help you determine the best course of action going forward.
Understanding Your Rights
Workers’ compensation is a no-fault system; this means that you do not have to prove that negligence or fault played any role in your injuries/illness. Instead, you must only show that your injuries/illness occurred while you were at work, as a result of your work-related duties or while you were carrying out said duties.
Once you have notified your employer of your injury/illness (within 30 days) and filed the DWC-1 form, your employer has 14 days to accept, deny, or delay your claim.
If your claim is delayed, there are a number of important things you should be aware of:
- Your claim must be accepted or denied within 90 days.
- During the delay, you are eligible to receive up to $10,000 for your medical expenses.
- The insurance company is not responsible for lost wages during the delay.
- You may be able to recover compensation for lost wages through the state’s disability program.
- You may need to visit a doctor chosen by your employer for your first visit, but you do not need to continue seeing this doctor; you may choose a doctor in the Medical Provider Network.
- You may need to be evaluated by a Qualified Medical Evaluator (QME) during the 90-day delay.
- If your claim is not denied within 90 days, it is presumed “compensable,” meaning you are eligible to receive benefits.
Get Started On Your Case Today
The Los Angeles delayed workers’ compensation claim lawyers at Hinden & Breslavsky can help you if your claim has been denied. We understand the various processes involved and, with over 150 combined years of legal experience, we know what it takes to fight for the maximum compensation you are owed.
Our team has represented thousands of injured workers throughout California and successfully recovered over $900 million. We are prepared to guide you throughout each stage of the process, answering your questions and addressing your concerns along the way.