How Long Does A Workers’ Compensation Claim Take?
The workers’ compensation system provides critical protection for workers who have suffered a job-related injury. The law requires your employer to purchase workers’ compensation insurance that pays a portion of your lost income and the medical expenses related to your injury.
The claims process only happens after some time but should not take an extended period. If you have a complex claim or have received a denial, you need help from an experienced workers’ compensation attorney.
Although you do not have control over the process and the timing, you can do your part to help ensure the process goes as smoothly as possible. You should take the time to get your claim right. Then, the rest is in the hands of the insurance company, which must follow state law when processing and responding to your claim.
To ensure a smooth path to workers’ compensation benefits in the shortest time possible, your first step should be to hire an experienced workers’ compensation lawyer in your area. Having legal representation can benefit you in many ways. They will keep your claim on track, avoid errors, and allow you to focus on your injuries and medical treatment.
Below is some information about the timeline of workers’ comp claims. Discuss your specific situation with a workers’ compensation attorney immediately.
Workers’ Compensation Claims Do Not Take as Long as Other Claims
Workers’ compensation cases should often wrap up in a more accelerated timeframe than personal injury cases. For example, if you have filed a car accident claim, your case may not conclude within the first year. The insurance company may take time to respond. Under state law, the insurance company cannot delay your claim indefinitely without having to pay it.
The main reason is that the law understands that you have a pressing need for the help that workers’ compensation provides. You cannot work while you have bills to pay. If you must go without compensation for an extended period, you may struggle to put food on the table or even worry about losing your home.
In addition, you need medical care urgently in the short term. You may need surgical intervention or extensive treatment from a doctor. Even if you had health insurance, you can lose your coverage if it was through your job and you can no longer work. Further, even if your health insurance provider picked up the costs, you may have your share of the costs to cover. You may have to pay deductibles or your co-payments.
Of course, this all assumes that you have health insurance. You are in a more dire situation if you do not have coverage. Some “skinny” health insurance plans barely cover a portion of your costs. Thus, you cannot afford to be without workers’ compensation benefits for an extended period.
Workers’ Compensation Claims May Not Involve Such Complex Facts
Another reason your workers’ compensation claim will be resolved quickly is that there is no need to determine fault in your case. Workers’ compensation benefits do not depend on fault. There needs to be more factual investigation required for most workers’ compensation cases.
At most, the insurance company will need to review your case to determine whether you suffered a work-related injury. First, they will need to examine your medical records to verify that you suffered an injury. Then, the insurance company will confirm that your injury happened on the job or was work-related. They can often verify these facts in a short time, especially following a clear-cut accident. Many workers’ compensation cases do not feature complicated points that can cause problems.
Factors That Could Affect the Duration of Your Workers’ Compensation Claim
The insurance company can take responsibility for your work-related injury in many cases.
However, these factors can affect the duration of your case:
- Whether you suffered an injury in an accident – if you suffered an injury that happened over time, such as carpal tunnel syndrome or another repetitive motion injury, the insurance company may take more time to investigate because there is a greater chance that they can deny your claim.
- Whether your claim arises from an illness or an injury – if you are claiming a work-related illness, the insurance company will investigate further to see if your condition resulted from your current job. They may try to claim that you were sickened at a previous job, and another insurance company will have an obligation to pay your benefits.
- The extent of your physical injuries – if you have suffered an injury more seriously, your claim can be worth more because you cannot work for an extended period. The insurance company may take longer to assess the claim because it means a more significant financial obligation for them. If your injuries are more complex, the insurance company will take more time to process and analyze the claim.
- The need for negotiations or settlement talks – if you have suffered a severe injury, your claim may be more complex. You may elect to enter into a one-time lump-sum settlement with the insurance company. It can take time to reach an agreement because you may have different ideas about the value of your claim.
In addition, whether you have suffered a temporary or permanent injury can determine the timing. If you have a permanent injury, you will receive a disability rating that will dictate how much you receive in benefits and for how long. You may not always agree with the rating that you have received.
You can discuss your final rating when you present your own medical evidence and conclusions about your condition. You do not have to accept the rating from the doctor that the insurance company forces you to see, especially because this doctor is on the insurance company’s payroll and possibly needs more objectivity.
Your Case Could Resolve Quickly Under the Best-Case Scenario
The entire workers’ compensation process can be determined within weeks. Everything begins when you notify your employer of your injury. State law gives you a certain amount of time to report your injury to your employer. If you miss that window, you lose the right to receive benefits. For example, California gives you 30 days to report a workplace injury.
There is no reason to delay reporting your injury because it can only complicate your case. Notifying your employer starts their time clock, where they have 14 days to accept, deny or delay your claim. The employer can inform you that they need more time to respond to your claim.
The Insurance Company Must Respond to Your Claim on Time
The insurance company does not get unlimited time to respond to your claim. The law recognizes a sense of urgency for the reasons mentioned above. You need the money to replace what you have lost from your job earnings. Even if the insurance company is short-staffed or they have their questions about your case, it does not matter. They are still subject to the exact timetable for every workers’ compensation case.
States give different amounts of time to respond to claims. In California, an insurance company must respond to your workers’ compensation claim within 90 days of filing it. If they do not answer by then, your claim is presumed to be accepted. Insurance companies usually respond within one month of receiving the claim in more straightforward cases.
For purposes of California law, a response means a decision either granting or denying benefits unless the insurance company has sent you a Notice of Delay.
A Denial Would Add Time to Your Claim
Your workers’ compensation case will take longer if your initial claim for benefits receives a denial. The law allows you to file an appeal if your claim was not initially successful. Although an appeal works on compressed timelines, your case still takes time. You have limited time to file an appeal after an insurance company denies your claim. State law will determine precisely how long you have to begin your appeal.
If your claim receives a denial, you can fight back. You have a limited time after the denial to file an appeal. In California, the time limit to appeal is one year from the date of denial. You will not take the entire year to appeal your case. Even though the insurance company can backdate your benefits if you eventually win your case, you do not want to take that long, especially when you are missing a paycheck. You should take every step to get your appeal its full consideration.
Still, you should take the time to fix whatever caused your claim to be denied and address the insurance company’s reasons for denial when you file your appeal. Your attorney will work to put you in the best possible position to win your case.
A lawyer may even contact the insurance company to communicate before you file an appeal. Your attorney might clear up the issues if the denial resulted from a misunderstanding. The insurance company may also not want an appeal because they will need to pay for an attorney for their case.
Appeals Will Take Time to Complete
Workers’ compensation appeals should take less time than an average court case. Usually, the Administrative Law Judge assigned to your case will issue a decision. The decision can take longer if your case has complex issues. If the decision does not go in your favor, you can request reconsideration with the judge.
If you are still unsuccessful, you will need to take your case to the court system. Again, the court process will be quicker than the average court case. You may get a decision from the court, although not in a hard and fast timeline.
Hiring an Experienced Attorney Could Make Your Claim Easier
Thus, you can expect the workers’ compensation process to take anywhere between one month to one year. If you have a complex workers’ compensation claim, you can minimize some hurdles and delays by hiring an attorney to help with your case from the beginning. Getting legal help can be an investment in the success of your case.
You can leave money on the table, or you may jeopardize your chances of benefits if you handle a difficult workers’ compensation case on your own. At a minimum, get a free consultation with a workers’ compensation lawyer to obtain their opinion about your case.
Your lawyer understands that timing is an issue in a workers’ compensation case. Your benefits will play a crucial role in your life. There is tension between needing to hurry to file your claim and waiting long enough to put your best foot forward with your claim.
If you make a mistake with your claim, you will introduce delays in your case. There are still delays, even if you can resolve the problems by speaking with the insurance company or filing an appeal. Thus, you should take the necessary time to get everything right.
Preparing Your Strongest Possible Case Could Reduce the Possibility of Delays
Here, preparing a compelling case will usually involve presenting enough evidence to show:
- You suffered an injury
- Your injury is related to your job
Even if your claim does not receive an outright denial, filing an incomplete claim with missing information can delay your payment. The insurance company may come back with questions or tell you you have failed to include the necessary information. Reach out to a personal injury lawyer.
In addition, you should know how much your case is worth if you negotiate a workers’ compensation settlement. Then, you can count when the insurance company makes a settlement offer that does not fully compensate you. For example, the insurance company can use a discounting mechanism to reflect the current value of money that takes too much from the amount that you deserve.