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What if there is a delayed or denied claims with my treatment?

Workplace injuries, illnesses or conditions are serious concerns for Californians who suffer from them. This is why they think that workers compensation benefits are the safety net that should allow them to lex so they can improve and return to full health. However, it is not always guaranteed that treatment will be provided or that it will be given in a timely manner. When a worker believes the denial or delay in treatment is unwarranted, there are options to complain and even receive payment for compensation after the delay or denial.

When there is a delay or a denial for treatment from the claims administrator for the case, there must be a reasonable excuse for this. If there is not one, the worker can be compensated. There can be a penalty payment for as much as 25 percent of the value of each service that was subject to delay or denial. The maximum amount that can be awarded is $10,000. A legal professional can be of assistance when seeking to get penalty payments. Also, an Information and Assistance officer (I&A) should be called.

It is also wise for the injured worker to complain about the delay or denial. The investigation into these issues will be conducted by the Audit Unit of the Division of Workers' Compensation (DWC). There are deadlines that the claims administrator must meet with the utilization review (UR). If they are not, the DWC can penalize them. Financial penalties are assessed by the Audit Unit if there is an unreasonable delay or denial of medical care or other benefits and their behavior shows they frequently do this as part of how they conduct business. The worker does not receive these payments as they go to the state.

Workers who have suffered injuries, conditions or illness on the job that is causing them to miss time and need medical treatment are justified if they are angry and concerned about delays or denials. Just as there are rules the worker must follow when getting workers' compensation benefits, the provider of care and the decision makers related to it must also follow rules. When dealing with delays or denied claims, having legal representation can make all the difference.

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  • San Jose: 408-624-8420
  • Oakland: 510-617-0556
  • Stockton: 209-881-9247
  • Sacramento: 916-668-7577
  • Salinas: 831-222-0988
  • Santa Cruz: 831-222-0855
  • San Luis Obispo: 805-475-3890

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