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Dawson and Rosenthal
Dawson and Rosenthal

San Diego Workers’ Compensation Insurance Lawyer

Workers’ compensation is an insurance measure that employers must provide in California to protect employees from an on-the-job injury. If you suffer an injury while on the job, workers’ compensation kicks in to pay for medical costs and some percentage of your wages. Because workers depend on this for help after an injury – and because it’s state-mandated – workers’ compensation bad faith issues are particularly heinous.

Workers’ compensation is the safety net California provides that pays employees who have suffered injuries on the job while they are unable to work. If you can’t work because of an injury and the workers’ comp insurer or employer refuses to pay, you need help from a San Diego bad faith insurance lawyer who understands the complications of local workers’ comp claims.

Depending on the accident, the cost to receive proper treatment can be massive. Plus, the loss of income during recovery can be crippling. California law requires businesses to carry workers’ comp insurance for employees. This applies to companies that range in size from a single employee up to hundreds of employees. Employees in San Diego can rest easy knowing that if something bad happens at work, workers’ compensation will cover the loss of income and medical expenses. Unfortunately, the insurance companies that provide the payout can be a different story.

What Do You Do After Benefits Have Been Stopped or Denied?

If your workers’ compensation claim in California has been denied or if your benefits have stopped after you have already been receiving them, there are various steps that you can take to reverse the decision. In the state of California, you need to appeal the denial of a claim or the cessation of benefits. There are various steps involved in the appeals process, including the following:

  1. Filing a case at an office of the California Division Of Workers’ Compensation (DWC).
  2. Filing an application for adjudication of the claim. If you want a judge to hear your workers’ comp case, you need to file this application in the county where you live or in the county where you sustained your injury.
  3. Receiving a notification from the DWC that will include your case number.
  4. Requesting a hearing with a document that declares your readiness to proceed have your case heard before a judge. This will be called a mandatory settlement conference.
  5. Attending the hearing, which will include you, the claims adjuster, your attorney, and the claims administrator’s attorney. If the case is not settled at this hearing, it will proceed forward to a trial.
  6. Going to trial is the next step, and you will need to have all the necessary documentation in order to present it to the judge. After the trial is over, the judge will deliver their written decision by mail, and you will receive it anywhere from 30 to 90 days after the trial occurs.
  7. If either you or the claims administrator dispute the judge’s decision, you can take an additional step and file a petition for reconsideration.

What Types of Injuries Are Covered By Workers’ Compensation?

It can be confusing to understand what types of injuries are covered by workers’ compensation insurance. In general, workers’ comp will cover most injuries that arise during the course of a person’s on-the-job duties. In other words, so long as an injury occurs while a person is completing an authorized work task, they should be able to receive compensation.

This can include a range of types of injuries, including acute traumatic injuries that may occur, such as the following:

  • Severe sprains or strains
  • Broken or dislocated bones
  • Traumatic brain injuries
  • Concussions
  • Severe lacerations or puncture wounds
  • Amputations or crush injuries
  • Internal organ damage or internal bleeding
  • Spinal cord injuries

In addition to these traumatic injuries, there are also many work injuries that occur over longer periods of time in the workplace that are just as detrimental to employees. This can include various types of repetitive motion injuries that occur after an employee performs the same movements over and over again for months or even years. Additionally, there are various types of injuries and illnesses that can occur as a result of exposure to hazardous conditions, toxic chemicals, or stressful environments. This can include cardiovascular diseases, respiratory diseases, occupational cancers, hearing and vision loss, and more.

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What Are The Types of Workers’ Compensation Bad Faith?

After an injury or major surgery, medical expenses can add up, and, with no income to make ends meet, life can come to a crashing halt. According to the Federal Bureau of Investigation (FBI), some companies fail to provide the full workers’ compensation payment, using the remaining funds for private use. This is just one type of bad faith claim for workers’ compensation that our San Diego bad faith insurance attorneys have seen. Other examples of workers’ compensation bad faith include:

  • Delayed payment
  • Denied claims
  • Failure to provide a reason for a denied claim
  • Lack of documentation
  • Failure to thoroughly investigate a claim
  • Lack of proper payment
  • Changing the facts on a claim
  • Failure to provide a termination notice 14 days before cancellation of policy benefits
  • Delaying medical treatment
  • Using a third-party to handle tasks such as billing and issue of payment

Any one of these examples is a reason to file a claim. California has laws in place to protect employees from exactly these situations, but it sometimes takes the authority of a San Diego workers’ compensation insurance lawyer to procure proper compensation. For more information on how to handle a bad faith claim, the California Department of Industrial Relations has an online resource full of useful information.

Proving Workers’ Compensation Bad Faith in California

Proving a claim is in bad faith takes work and documentation showing failure to process the claim, a denial of a claim with no reason attached, or payment for a much smaller amount than the policy is for are all good evidence for building a case. This can be a very tricky process, especially if the insurance company is not willing to provide documentation or if the case turns into a game of he said, she said.

Be sure to keep a file filled with all the documentation related to the case. Records of healthcare visits, hospital stays, rehabilitation therapy, and pay stubs from before the accident are all necessary forms of proof. Also, keep any correspondence from the insurance company, a record of any phone calls, and any other documentation that might be relevant.

Why Do You Need a San Diego Workers’ Compensation Bad Faith Attorney?

Having a workers’ compensation attorney on the case is a necessity in workers’ compensation bad faith cases. A law firm with 50 years of experience is more likely to know exactly how to handle a court case and will procure a higher settlement. In California, damages for a bad faith case include legal fees, making it worth having peace of mind and a legal team on your side.

Workers’ compensation laws are in place to protect workers against unfair treatment. Don’t let medical bills and lack of wages become overwhelming before acting. Let our law offices handle your claim and get you back on the road to financial recovery. Contact Dawson & Rosenthal, P.C. today for a free legal consultation.