Dealing with the aftermath of an accident is frustrating. However, laws are in place to protect the injured.
California employers, for example, must have workers’ compensation insurance coverage for employees by law. Keep in mind, however, workers’ compensation insurance companies may not have your best interest in mind. This is where a workers’ compensation attorney comes in.
California is also a fault (tort) state. Meaning a person must be found responsible (liable) for and then payout damages after an accident. Proving liability gets tricky because there must also be proof that the responsible party acted negligently.
Each case is unique, and it’s hard to estimate how long it will take to settle. However, the process typically unfolds like this:
- Notifying your employer
- Filling out a workers’ compensation claim
- Filing the claim with your employer
- Getting medical treatment
- Your claim being accepted or rejected
- Settlement discussions
- Reviewing the decision and deciding whether to appeal
- Dealing with the workers’ compensation appeals board
- Medical attention
- Consultation where details will be discussed
- Medical costs
- Legal options
- Investigation of claim and medical records · Insurance claim or demand letter filing
- Lawsuit filing
While the path is clear, the time it takes to get there is fuzzy. Several factors affect the length of a case including varying recovery times, document gathering, additional treatment, and whether your employer’s insurance company requests a second opinion.
Some of the common causes of delays in accident cases are:
- Ongoing medical treatment or still receiving medical treatment
- The extent of your injuries or impairments can’t be determined until you have reached “maximum medical improvement” (MMI).
- Insurers reluctance to pay
- Insurance adjustors are looking out for the insurance company and may choose not to pay certain benefits or deny your claim altogether.
- Flagged claims (fraud investigations)
- While the workers’ compensation system was intended to protect employees, there is a high percentage of employees who are trying to exploit the system.
- Missing a medical appointment
- Not only can rescheduling medical appointments present a red flag to insurance adjusters, but it can also delay your recovery and ultimately your case.
- Severe injuries
- Complicated injuries require more treatment, and treatment must get approved — approval times vary.
MMI mentioned above is the driving force for closing a workers’ comp case. Only your doctor – not your lawyer, employer, or insurance company can determine MMI. It’s important not to rush the MMI date, as you may not receive the total compensation you require to cover your needs. It can be that the doctor is not able to identify the extent of your injuries until months into your recovery.
You may feel pressure from the insurance company to settle because they will attempt to keep their costs (your payout) to a minimum. It’s important to consult with your attorney and follow his advice because he has your best interest at heart.
Once you settle, you are no longer eligible to receive weekly benefits for those injuries. The benefits you could miss out on include weekly workers’ compensation (for up to 104 weeks), payment of medical bills, and vocational rehabilitation.
The importance of receiving the maximum compensation for your claim becomes vital if you do not have a job to return to. An experienced and knowledge workers’ comp attorney can identify the true value of your claim and negotiate to maximize your settlement.
It’s important to note to that workers’ compensation laws and benefits, as well as personal injury laws vary by state, so it’s important to consult with an attorney licensed to practice in the state you’re employed in.