Resolving Delayed Claim Matters
After you file a workers’ compensation claim, the insurance carrier for your employer has several options. They can accept or deny your claim, or they can delay their decision until they complete their investigation. Some claims adjusters may employ delay tactics, even if they have formally accepted your claim. Not all workplace injury cases can be resolved quickly, but injured California employees can take steps to avoid or resolve delays in settlement or payment decisions.
There are several reasons that workers’ comp claims get delayed:
- Your employer waits the full 90 days to accept or deny your claim.
- The claims adjuster sends a formal letter of delay requesting more information.
- The Workers’ Compensation Board wants to wait until you have reached maximum medical improvement before making a final decision about your settlement.
California employers have 90 days to review workers’ comp claims. However, the claims administrator must authorize payment up to $10,000 for reasonable medical treatment starting the day after you file your claim. If no decision is made within these 90 days, your claim is presumed to be accepted.
A letter of delay should only be sent in good faith — that is, if there is a legitimate need for additional information to resolve the case. Adjusters should not make unreasonable demands but you can avoid a delay by filing all necessary paperwork correctly. An experienced workers’ compensation attorney can make sure the information you provide is thorough and accurate and can also help you get an opinion from the right medical professional if there is a question about your maximum medical improvement. If you have documentation that your paperwork was filed correctly but ignored, your attorney can request a hearing with the Workers’ Compensation Appeals Board.
A knowledgeable California workers’ comp lawyer can help prevent an unnecessary delay and take steps to resolve any issues holding up a final decision about your payments.