All employers in Van Nuys and all across California are required to have workers’ compensation insurance to ensure that employees who suffer from work-related injuries and illnesses get the medical care they need in a timely manner.
California employers also have an option to be self-insured, but the cost and legal headaches of being self-injured alienates them and prompts them to purchase workers’ comp health insurance to be spearheaded by private insurance companies.
So who will be handling your workers’ compensation claim when you report your workplace injury to your employer? In most cases, the employer’s insurer will investigate and either approve or deny insurance coverage unless the employer is self-insured.
Negotiating with insurance company vs employer
While it may seem that insurers should be on your side and be more willing to approve your claim after a work-related injury, it is not always the case. In fact, contrary to the popular belief, negotiating with your employer would be much easier as opposed to negotiating with profit-driven insurance companies.
“Many insurance adjusters are hostile, unprofessional, and difficult to work with,” explains our Van Nuys workplace injuries attorney at the Koszdin, Fields & Sherry law firm. “But that is the least of your concerns, as large insurance companies in California tend to employ unfair insurance claim practices and tricks in order to minimize the value of your claim or deny coverage altogether.”
That is why the importance of being represented by a workers’ compensation attorney in Van Nuys or elsewhere in California cannot be underestimated.
How do insurance companies investigate workers’ comp claims?
But what does your employer’s insurance company do after you file a workers’ compensation claim, exactly? After reporting your work-related injury to the employer, he or she will notify his/her insurance company. The employer’s insurer is supposed to review your claim right away and launch an investigation into the workplace injury.
The workers’ compensation investigation by insurers involves a broad spectrum of steps, including but not limited to:
- The insurance adjuster will reach out to you to find out all the details about the workplace accident that caused your injury;
- Speak with your employer;
- Contact any witnesses to confirm what they saw;
- Reach out to your treating physician to verify the extent of the injury and disability suffered by you; discuss the prospects of your recovery and how this injury affects your earning capacity and ability to perform your job;
- Review medical documents about the workplace injury, particularly the diagnosis and prognosis, as well as your past medical records.
“Depending on how that investigation goes, your workers’ compensation claim will either be approved or denied,” says our Van Nuys workplace injuries attorney.
Approval or denial of workers’ compensation claims in California
After the investigation has concluded, the insurance company will have to decide what to do with your claim: to approve or deny it. It is not uncommon for insurance companies to ignore claims or take too long to investigate claims, dragging their feet in an attempt to avoid paying for your medical bills and lost wages.
However, California workers’ compensation laws require insurance companies to approve or deny claims within 90 days from the date the claim was filed. If you have not heard back from the workers’ comp claims administrator within 90 days and have not received a letter denying your claim, it may mean that your claim has been approved.
If your employer’s insurance company delays the investigation and/or keeps running around in circles without giving you a definitive answer, consult with an experienced workplace injuries attorney in Van Nuys or elsewhere in California. Even if your claim has been denied, you can file an appeal and get a second chance to prove that your injury is work-related and you are entitled to workers’ comp benefits.