Frequently Asked Questions
What if I receive a “Delay Notice”?
After you report the injury, the insurance company has fifteen (15) days to either accept your claim and pay benefits, deny your claim, or issue a “delay notice.” If your claim is placed on delay, they have up to ninety (90) days from the date you submitted a claim form to investigate and make a decision whether to accept or deny your claim.
During the delay period, the insurance adjuster may call and ask you questions, and may even send a private investigator to take your recorded statement. They will also talk to your employer and co-workers. Unfortunately, they’re goal is often to find something –anything– they can use to deny your claim.
During the investigation period the insurance company must provide you with up to $10,000 in medical treatment, but you should remember they are sending you to doctors they select, and they will often refuse to authorize certain necessary treatments. Furthermore, many adjusters even call your treating doctor directly to try to obtain information they can use to deny the claim.
Finally, during the delay period, the insurance company is not required to pay temporary disability benefits to you, even if you are taken off work for the injury. This often resulting in significant financial hardship. For all of these reasons, we recommend that if your claim is placed on Delay, you contact Valley Law Group as soon as possible.
What if my claim is Denied?
If you receive a “Denial Letter” this means the insurance company is claiming you did not have an injury at work, and they are refusing to provide you with any further benefits. To combat this, you will need to obtain an evaluation from a “Qualified Medical Evaluator,” file an Application for Adjudication with the Workers’ Compensation Appeals Board, and likely go to trial to contest the denial.
If your claim is Denied, you should obtain a qualified attorney right away, and you should never select a Qualified Medical Evaluator from the State Panel list without first speaking to a knowledgeable attorney. Insurance companies have many, many traps for unrepresented injured workers, so if your claim is Denied, call Valley Law Group right away.
What if I’m an independent contractor?
Have you been told that you cannot get workers’ compensation benefits because you’re an independent contractor, not an employee? This is an often-used trick by employers who are trying to avoid paying taxes and workers’ compensation premiums, but its’ usually not true. Even if you are paid as an independent contractor and even if your employer isn’t insured, you may still be entitled to receive workers’ compensation benefits. However, this is a very complex and constantly changing area of law, so it is vital that you have a highly qualified attorney. Valley Law Group handles many of these
What if my employer doesn’t have workers’ compensation insurance?
California law requires that all employers carry workers’ compensation insurance. Some employers simply ignore this law, while others try to get around it by claiming that they have no employees, only independent contractors. However, the rules of independent contractor status are very hard to meet, so many “contractors” are really employees for workers’ compensation purposes. Furthermore, even if the employer has no insurance, there is a way to get the benefits you need.
If the employer is unable or unwilling to provide medical treatment and other benefits directly, you can obtain these from a special fund set up by the State of California. It’s called the Uninsured Employers’ Benefits Trust Fund (UEBTF). Cases against UEBTF are very difficult and time consuming, so it’s important you have a law firm that has experience in this complex area. Valley Law Group is a leader in uninsured employer cases, and we will work diligently to fight for the benefits you deserve. Give us a call today.
What if I’m not satisfied with my medical treatment?
When you file a workers’ compensation claim you will be sent to a doctor in the insurance company’s network. These doctors have been carefully selected by the insurance company and are often given strict treatment guidelines to reduce the cost of care. This means that instead of providing necessary diagnostic studies and treatment to cure the problem, they will often just prescribe medications to mask your pain, and then send you back to work.
What you may not know is that you can select a different doctor from the network, and even the worst network often has a few good doctors. At Valley Law Group, we know who the good doctors are, and can assist you in finding the one who is right for you. Furthermore, if the insurance network doesn’t meet all the legal requirements, you may be able to select the doctor you want even if he or she is outside the network. Valley Law Group is dedicated to making sure our clients have the best doctor possible. Call us, and we’ll work with you to obtain the treatment you need with a doctor who cares about you.
What if my employer won’t honor my work restrictions?
After a work
What if the doctor is sending me back to work, but it still hurts?
Doctors in the insurance company’s network are encouraged to get you back to work as quickly as possible. This saves the insurance company money since they don’t have to pay temporary disability benefits. But if you return to work too early, it often prevents your injury from healing correctly or even causes greater injury.
If you feel your doctor isn’t listening to you and is returning you to work before your body is ready, you probably need to get a new doctor and argue for greater work restrictions or temporary disability. This is hard to do on your own, so call Valley Law Group and we’ll help you obtain a doctor who will listen to you and provide the treatment and work restrictions you need.
What if I’m not receiving temporary disability?
If you’re unable to work because of an injury, you are entitled to temporary disability payments.
Insurance companies try to deny these benefits in many ways. They may delay or deny your injury, claim you are a “seasonal worker” who isn’t entitled to benefits, or obtain a doctor’s report which wrongly states you can go back to work. Sometimes insurance companies just refuse to issue benefits even though they know they are owed and have no excuse. No matter the reason, this is wrong. Valley Law Group can help you obtain the temporary disability benefits you deserve, often with an added penalty against the insurance carrier. Call us today.
What is a QME?
“QME” stands for “Qualified Medical Evaluator.” This is a doctor whose job is not to treat you, but to review all the medical reports and records, evaluate you, and provide an expert opinion on issues of temporary disability, permanent disability, work restrictions, future medical care, and other important issues to your case.
If you have a treating physician who has provided you with the level of permanent disability you deserve, the insurance company will probably object to the treater’s report and request a QME panel because they want to lower your disability level so they can pay you less. On the other hand, if the insurance company agrees with the treater’s report (usually because it finds a very low level of disability) they will want to settle your case based on that
When requesting the panel you have the opportunity to select the doctor’s specialty. The State of California will then send both you and the insurance company a list of three doctors, and you can select the one you want to go to if you follow the time limits. If you don’t select one timely, the insurance company can do it for you.
If the insurance company requests a QME panel, if they give you the opportunity to request one, or if you receive a “
Some panel doctors write reports that are very favorable to insurance companies, and you want to avoid these doctors at all costs. Valley Law Group can help you select both the specialty and the doctor so that you get a QME who is fair and will provide you with the benefits you deserve.
The insurance company wants to settle my case. What do I do?
The insurance adjuster’s job is very simple – settle your case for the lowest amount possible, because the less an insurance company pays, the higher its profits. This is very different from your goal – to make sure you receive the medical treatment you need, the benefits you deserve, and that you can continue working until you’re ready to enjoy retirement.
We’ve had many clients walk into our office with a settlement offer from the insurance carrier, thinking that the offer was fair. More often than not, however, the offer was far too low. If the insurance company starts talking to you about
What should I look for in a workers’ compensation attorney?
You have many options to choose from when it comes to attorneys, and if you’ve never hired an attorney before, you may not know where to begin.
- Only use a local attorney – Don’t be fooled by the Los Angeles law firm that advertises in the Central Valley. You want a local firm where the attorney and his staff can meet with you in person. Out of town attorneys often spend more time and money marketing than they do
representingyou, and when it comes to appearing in court or depositions, they often hire an inexperienced “contract attorney” who’s never seen your case before. Always get a local attorney.
- Obtain a free in-person consultation – Some firms will want you to sign up without ever speaking to an attorney. You might speak with a paralegal, a “case manager,” or even an “intake specialist.” These are not attorneys, they don’t know the law, and their job is to sell you the services of the law firm they work for. If the attorney isn’t willing to meet with you before you sign up, he probably won’t be the one working on your case either. This means you won’t be getting the representation you deserve. Never hire an attorney without getting your free consultation and
- Use a Small to Mid-Size Law Firm – Don’t get me wrong, there are some very good large firms out there. But the chances are that the larger the firm, the more impersonal the service. If you want personal service, stick with a small firm. They can provide the same quality of representation and give you a better experience on the way.
When you talk to a prospective law firm or go for your free consultation, be observant. Is the telephone answered by a live person? Are you greeted by a friendly receptionist? Are you provided a comfortable place to wait for the attorney and offered something to drink? Is the office quiet and organized or loud and hectic? Are you made to feel comfortable? Do they have experience in multiple areas of practice? These are clues that it’s a well run office, and perhaps one you should consider. Give us a call. If you’re outside our geographic area, we can certainly refer you to a high-quality local attorney near year.
I have an attorney, but he won’t return my calls. What should I do?
The most common complaint against attorneys is that they don’t return calls. In a way, this is understandable, because unlike many professionals, attorneys are often out of the office … at court and in depositions. However, this must be balanced by the need to communicate with clients.
At Valley Law Group we have the following system in place to answer your questions:
- Your call is initially handled by a secretary or paralegal assigned to the case.
- If they are unable to immediately answer your question, they will either research it and respond to you within one business
day,or refer the question to the attorney.
- Depending on the urgency, the attorney will either call you back within one business day, reply
If you’re unhappy with your current attorney, you do have the option of changing attorneys. As a general rule we prefer not to accept cases initially handled by other attorneys, but we are still willing to meet with you and will consider each situation on a case-by-case basis. If you’re unhappy with your current attorney, give us a call and we’ll see if we can help you get the responsive representation you deserve.