Resolving A Disputed Workers Compensation Claim
We can appeal the denial of your claim
After filing a claim, you may face a long dispute with your employer and their insurance company regarding the circumstances or scope of your injury. You may have difficulty getting medical treatment or compensation for lost wages and some claims are denied. Your costs may be significant, or you may be left without treatment you need, especially if the insurance company denies surgery. The whole workers compensation process can be exhausting. You may find yourself asking what you should do. That's why it's so important to have an experienced attorney on your side.
Every claim is eventually resolved, usually through a settlement. Indeed, California law requires the parties involved in a workers' compensation case to attend a Mandatory Settlement Conference (MSC) before going to a trial before a judge. In California, workers' compensation cases can be resolved through two types of settlements:
While it is theoretically possible to resolve a disputed workers' compensation claim on your own, we can't recommend it. If you go up against a trained claims administrator - and your employer's attorneys - on your own, you'll go into settlement negotiations at a serious disadvantage. That's why you need Robert A. McLaughlin, APC on your side. We know why claims are denied and disputed and how to fight back. Call us today.
What happens to medical bills when a workers comp claim is denied?
If your injury is found to not be work-related or your claim is denied for another reason, you may be on the hook for your medical bills and related expenses. You can appeal the denial of your claim with the help of an attorney.
What is a Compromise and Release?
The first type of settlement, a Compromise and Release, is designed to close the entire case in a single lump sum payment rather than awarding payments over time. The injured worker and the employer or insurance company agree on an amount that will pay for the entire cost of the worker's disability as well as any future medical care. Once a Compromise and Release is agreed upon and the money changes hands, the case is over.
In most cases, you can only seek a Compromise and Release if you are no longer working for the employer with which you were injured. Most employers do not want to settle by way of Compromise and Release with someone who is still working for them because the case effectively isn't over. If you re-injure yourself, they will have to pay medical benefits again.
What is a Stipulated Finding and Award?
A Finding and Award is the term for a judge's decision in a workers' compensation case. A Stipulated Finding and Award is an agreement between the two parties that has the same effect as a judge's decision. Both the injured worker and the employer voluntarily enter into the agreement, which is then reviewed and signed by a judge.
This type of settlement includes two main components: a percentage of disability and a determination on the need for further medical care. Disability benefits are determined using a complex formula that draws from the language in the medical report as well as your age and occupation. These benefits will be paid over time.
The settlement will also indicate whether you are, may be or are not entitled to payment for further medical care for the injury. If your settlement indicates that you are or may be entitled to payment, you may have to contact the claims administrator prior to receiving care.
If you and your employer's insurance company cannot come to a settlement, the case will go to trial. Workers' compensation trials are held before an administrative law judge (ALJ), who will hear arguments from both sides and come to a Finding and Award.