When you have been injured in a workplace incident, you may require medical benefits to help you to recover, recuperate, and get back to work. While your employer’s worker’s compensation insurance scheme should entitle you to receive medical benefits, it is not uncommon for Lancaster employees to encounter issues when attempting to claim. For the most part, these worker’s compensation schemes are funded by insurance companies, meaning it is in their own interests to either minimize the financial benefits you receive or deny your claim outright.
Should this happen to you, do not panic. Having a medical benefits claim denied or reduced can be an incredibly stressful experience, particularly when your family relies on your income, but an outstanding Lancaster medical benefits attorney from Koszdin, Fields & Sherry could litigate on your behalf, protecting your rights and securing the worker’s compensation you deserve.
Medical Benefits Must Be Claimed Within a Strict Time Limit
One of the common reasons why medical benefits claims are rejected relates to the timeframe in which a claim can be filed. Under California law, which is applicable in Lancaster and surrounding areas, workers compensation claims must be submitted within the following timescales:
- Your injury must be reported within 30 days, and the sooner the better
- A workers’ compensation claim must be filed within one year of this date, where your insurance company has not paid any of the benefits
- Where the insurance company has provided some benefits, a claim may be filed within 5 years
Leaving it too long before filing your claim can lead to suspicion about the validity and authenticity of your claim and, as such, it is recommended that you seek worker’s compensation benefits as soon as possible.
Regardless of whether you intend to claim medical benefits, all accidents and injuries, workplace or otherwise, should be reported immediately. Seek medical advice as soon as possible when you sustain any kind of injury.
What Medical Benefits Am I Eligible For?
Although medical benefits available to you depend largely upon your injury, the most common benefits include the costs of medical treatment directly related to your injury. This may include:
- Visits to physicians and specialists.
- The costs of prescription medications and pharmaceuticals.
- The costs of durable medical equipment and supplies.
- Surgical procedures.
- Hospital stays.
- Physical or occupational therapy related to the injury.
Medical benefits are initially limited to $10,000 until the workers’ comp claim has been properly investigated. Once the claim is approved, that limit is generally lifted.
Lancaster Medical Benefits Claim was Filed Promptly – Why Was It Denied?
When treatment is proposed for an injured party under a workers’ compensation claim, insurers typically have an independent physician review the proposed plan for treatment. This is known as a utilization review or med-legal exam. These reviews do not always result in approval of the medical treatment, which is the point at which it is often necessary to reach out for legal help.
As a Lancaster medical benefits attorney from Koszdin, Fields & Sherry has extensive experience in handling cases of this type, they are familiar with the common reasons for denying claims like yours. Aside from the time issue, there are several reasons regularly given by insurance companies when reducing or outright rejecting claims.
Offsite and Preexisting Injuries – Sometimes medical benefits claims are denied as the insurance company believes that your injuries were sustained either outside of working hours or were due to a preexisting condition.
Minor Injuries – If your injury is not believed to be severe enough to require time off work, your employer and their insurance company may deny your claim.
Denied, Now What?
It is not uncommon for workers’ compensation carriers to deny medical benefits claims or to deny parts of the claim. You are well within your rights to fight the denial of your workers’ compensation claim for medical benefits. If you have received a letter denying your claim, then you can challenge the denial. This challenge occurs before representatives of California’s Division of Workers’ Compensation (DWC). Usually, appeals are filed with the closest district office of the DWC.
Disputes in which the insured party does not agree with the denial of medical benefits or other aspects of the case are resolved by a judge. The process of appealing a denial is complex and involves filing an application for adjudication of the claim and, soon after, a declaration of readiness to proceed. This allows you to request a hearing and describe the issues that have lead to the dispute. You (and your Lancaster medical benefits attorney, if you choose to be represented by one) then appear at a special hearing to determine whether the denial was appropriate or not.
If a judge finds that benefits were delayed or denied unreasonably, then the carrier may be assessed a penalty of 25 percent, or up to $10,000.
If your medical benefits claim has been rejected for any of the above reasons, or another which we have not mentioned, a highly skilled Lancaster medical benefits attorney could help you to secure the benefits you are entitled to.
This may include seeing your case through to a compromise and release agreement. The agreement not only ends the case and settles the question of any permanent disability, but also secures future costs of medical care related to your injury.
You should not suffer alone after a workplace injury. At Koszdin, Fields & Sherry, we understand how devastating the impact of losing your income can be, for both you and your family.
To enlist the services of an expert Lancaster medical benefits attorney, schedule your free initial consultation today by calling us on 818-812-5639.
