Workers’ compensation covers the medical expenses and lost income of a worker who suffers an injury or develops an illness as a direct result of their job. However, the losses an injured victim incurs following a serious injury or illness often go far beyond just medical bills and lost wages, which leaves many injured workers wondering what happens if their benefits don’t fully cover the full extent of their losses.
Were you injured on the job? The Los Angeles workers’ comp and personal injury lawyers at LNN can help. Contact our office online or call (213) 513-5614 today to arrange a free consultation. In your initial meeting, we will explain your rights and determine whether you might be entitled to compensation in addition to your workers’ compensation benefits.
What Is Workers’ Compensation Insurance?
Workers’ compensation is a type of business insurance that provides benefits to workers who were injured or became ill as a direct result of their jobs.
Under California Labor Code 3700, workers’ compensation is mandatory for all employers, regardless of the amount of employees. Companies are required to maintain coverage if they have one or more employees who regularly work in California, even if the company’s headquarters are in another state.
How Do I Receive Workers’ Comp?
To receive benefits, an employee must report the injury, submit a claim within a certain time frame, and meet all the necessary requirements for coverage. They do not, in any way, have to prove their employer was at fault for their injury or illness to receive their benefits.
If the claim is not submitted in time or is denied, the worker can file an appeal. Appealing the denial can be challenging, so it is highly recommended to work with a workers’ compensation attorney during the appeals process.
What Does Workers’ Comp Cover?
Workers’ comp provides basic benefits to injured or ill workers. These benefits cover an employee’s medical expenses, lost wages, and costs for rehabilitation. If the worker is disabled, the employer-provided coverage will also provide temporary or permanent disability benefits. Other available benefits include supplemental job displacement benefits and a return-to-work supplement.
Should the employee die as a result of their injuries or illness, workers’ compensation will provide monthly death benefits to the worker’s surviving spouse, children, or other eligible beneficiaries.
The benefits received vary and are calculated based on the worker’s injury, age, type of employment, and change in earning capacity.
Can I Receive Additional Compensation to Cover My Bills?
Although workers’ compensation benefits are said to cover the costs of work-related injuries and illnesses, they often cover only a portion of your losses. In some circumstances, you can seek additional compensation to cover the full extent of the expenses and other losses associated with your work injury or illness.
If your employer was aware of an extremely hazardous situation and failed to remedy it, you may be able to file a personal injury lawsuit to recover damages. However, unlike workers’ comp, to successfully secure compensation, you and your attorney will need to prove your employer was negligent.
Are You Responsible for Your Medical Bills When a Workers’ Comp Insurer Does Not Pay Them?
By law, your employer’s workers’ comp insurance carrier must pay your medical bills directly. What typically happens when your claim is denied is that doctors and hospitals will invoice you directly. You can then submit those bills for payment by your own health insurance company, or you can pay them yourself. In either case, you can continue to pursue your workers’ comp claim, and you or your health insurer can seek reimbursement for payments when your claim is approved.
You may not know that your claim has been denied until you receive a bill directly from a doctor or health care facility. Rather than accepting that denial and immediately remitting payment, contact your employer and its workers’ compensation insurance company to determine why your claim was rejected. Hire an experienced lawyer to handle those communications on your behalf. Our lawyers know how to interact with insurance adjusters and can advocate aggressively on your behalf to reverse improper claim denials.
How Do You Appeal a Workers’ Compensation Claim Denial?
If your employer’s workers’ compensation insurer denies your claim and refuses to pay your medical bills, how you manage what happens next can make a critical difference in reversing that denial. Your most important step is to carefully review the denial letter that you received to fully comprehend the reason for the rejection of your claim, and to start the appeals process within 30 days of the date of that letter. If you miss this 30-day window, you will likely forfeit your right and opportunity to have your medical bills covered.
Legal reasons for denial include that you submitted your claim too late or did not include required information to substantiate the claim. Medical reasons for the rejections include that the insurer believes you suffered the injury other than in a work-related activity or that the injury will not prevent you from doing your job. In either case, you will need objective evidence to rebut the insurer’s argument. That evidence can include statements from witnesses who saw how you were injured, your medical records from before and after your injury, and your employer’s records of when you submitted your injury report and any investigations or reviews your employer conducted after it happened. A medical denial will also likely require you to be examined by a Qualified Medical Evaluator who will provide an independent opinion about your injury. In either case, you should consult with a lawyer to determine how best to respond.
Your lawyer might submit an application for adjudication to begin a formal claims denial appeal process, request a mandatory settlement conference, or ultimately prepare your case for a trial. No two workers’ compensation cases are the same. If you attempt to get a workers’ compensation insurance company to pay your bills without an attorney’s help, you will be fighting on an uneven playing field against an opponent that has substantially more experience than you do.
The attorneys at LNN are dedicated to getting justice for all. We understand the frustration you might experience when your medical bills are piling up because workers’ compensation is not paying them. We have the knowledge and experience to push back and to compel the insurer to pay your bills.
Contact a Workers Compensation Lawyer in Los Angeles to Learn More
Did you get hurt or sick at work? If you suffered severe injuries or developed a serious illness, your workers’ comp benefits will likely not cover all of the costs. Fortunately, you might be entitled to compensation in addition to your workers’ compensation benefits.
The legal team at LNN is dedicated to helping injured workers get back on their feet. We understand just how devastating a work-related injury or illness can be. That is why we advocate so strongly to get you the compensation you need. We have successfully recovered millions of dollars on behalf of our clients. So, if your workers’ compensation claim has been denied or you feel you may be entitled to additional compensation, our Los Angeles workers’ comp lawyers can help. Contact us online or call (213) 513-5614 to schedule your FREE consultation.
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