The Significance of a Denied Claim In California Workers Compensation Practice
A "denied" claim can still be settled by your attorney for permanent disability (PD). In California your treating doctor can help you qualify for EDD benefits in lieu of temporary disability (TD) benefits. There are advantages and disadvantages in re to medical treatment when a claim is denied.
My Workers Compensation Claim was Denied by my Employer or its Insurance. What Does That Mean To Me?You will not receive temporary disability payments while your claim remains denied, but your treating doctor can assist you in applying for State Disability (EDD) benefits as a substitute for the TD which is denied. Also your treating doctors will need to be willing to be paid on a lien basis. That means the doctors will wait until the conclusion of your case when your PD claim is settled to be paid.
Can My Claim for Permanent Disability (PD) be Settled Now that my Claim Has Been Denied?At least 80% of the files in my office are now, and have always been denied claims. With very few exceptions I am able to settle all of them. Your PD claim is not reduced in value by virtue of the fact that the claim was denied. At the time of the Madatory Settlement Conference (MSC) if you are still owed any amount of TD your attorney will be able to negotiate for the defendant to pay you that amount as well as the PD amount that is agreed upon.
Is There a Way For My Claim To Be Transformed Into An Admitted Claim?In most all workers compensation claims in California the Defendant will require the injured worker to be evaluated by a neutral doctor known as an agreed medical examiner (AME) or Qualified Medical Examiner (QME). If the neutral doctor issues a report finding that the injury was industrial, the case will normally be treated as an ademitted injury thereafter.
Are There Any Advantages To Me Now That My Case Has Been Denied?Claimants with denied claims do not need to treat within the Medical Provider Network (MPN) of the employer or insurance company or claims administrator, so a doctor chosen by your attorney is sufficient. That is often a huge advantage, especially with organizations who expel all doctors who try to be fair to the injured worker. Also a denied claim is not subject to utilization review (UR) and Independent Medical Review (IMR), processes which have not been of particular benefit to injured workers for the most part.