One of the first things that an insurance company will do is not even a delay tactic. They might send you to an industrial medical clinic, that your employer sends everyone who reports a work injury. These contracts are profitable for the clinics, so they will try to get you back to work as soon as possible in order to maintain their contract with your employer or the workers’ compensation insurance company. It doesn’t matter how much pain you’re in; if you can raise your arm after an arm injury, they’ll send you back to work with some minor restrictions that are usually not the restrictions that you really need.
If that doesn’t work, one of the biggest delay tactics insurance companies have at their disposal is simply denying the medical treatment. After the treating doctor makes a request, it must be reviewed and approved through the insurance company. The insurance company often finds a way to say the treatment is not medically necessary in order to deny the treatment. They also might say they need more information, knowing that the doctors are really busy and may not get them the information they need or even realize it was requested. This tactic is designed to delay and confuse you, in the hope that you’ll become so fed up with the process you’ll accept a small settlement. They want to be rid of you and to close your claim because the longer your claim is open, the more it will cost them.
If you have a good attorney, your attorney will know how to appeal the denial. Your attorney can also stay on top of the doctors to make sure if additional information is requested, the doctor knows about it. The insurance company will have to try different tactics if you have an attorney.
If it’s a major injury, the insurance company will try to deny certain treatments like surgery and make it take longer for you to get approved for any operations. They might make you go through the appeals process, and even if you win the appeal with your lawyer, you’ve lost 60 to 90 days, during which time you could have had the surgery and already recovering.
Insurance companies know that if they deny medical treatment and their decision gets upheld after appeal, you can’t get that treatment for an entire year. They count on people having financial situations that will induce them to settle for a nominal amount after encountering their delay tactics.
How Are Workers’ Compensation Benefits Calculated in California?
Temporary disability is calculated at two-thirds of your average weekly wage There is a minimum and a maximum amount. Someone whose calculation comes to $70 a week would be paid $194.91 per week, and a high earner would be capped at $1,299.43 per week.
Permanent disability is a little more complicated. The easiest way to explain how permanent disability is determined would be to say that the doctor will give you a percentage for each body part that’s injured or for each medical condition (i.e., depression, high blood pressure, diabetes, or even some type of internal injuries caused by exposures to a chemical). Once the doctor gives those percentages, it’s up to me as an attorney to use a mathematical formula to come up with your final percentage, which will determine the number of weeks you are entitled to receive payments for your injury. The maximum you can get paid for your permanent disability is $290 a week, so if you received ten weeks of payments, you get $2,900 for your injury. If you had one hundred weeks, you’d get $29,000.
For more information on Workers’ Compensation Cases in California, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (323) 991-5915 today.
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