Sometimes things don’t go as expected in Workers’ Comp cases. Insurance companies often don’t do a proper job, resulting in delays and other issues that hinder the process.
If you believe you are owed penalties and sanctions regarding your case, here are a few things you should know.
1. Seeking Penalties and Sanctions
There are many reasons to get penalties and sanctions paid to you through California’s Workers’ Compensation System. The most common are:
Your Treatment Is Not Authorized on Time: Insurance companies may have time limitations to conduct a Utilization Review, which is the process to authorize or deny the treatment. In this case, you can seek penalties and sanctions or seek the treatment itself.
Your Money Is Not Being Paid on Time: This means it is missing either a permanent disability or temporary disability check or the reimbursement for out-of-pocket expenses.
2. How Should I Start an Appeal Process?
If you want to start an appeal, the first thing to do is go to the Workers’ Compensation Appeals Board (WCAB). You must file a petition with the WCAB and notify them that you intend to seek penalties and sanctions and will also be presenting other issues for trial.
Then, file a declaration of readiness to proceed and indicate the issues along with penalties and sanctions.
In addition, you need to request a mandatory settlement conference, which is a hearing where you can set various issues. Make sure you don’t choose an expedited hearing because it only addresses treatment issues.
3. Can I Do This on My Own?
This is a complex procedure; it is recommended to hire a Workers’ Compensation attorney who knows the system and Labor Codes. But if you want to figure it out yourself, check out some of these CA Labor Codes.
Keep in mind that these are burdensome things to read. Some lawyers still struggle with them, but there are available for you to read.
Labor Code Sections:
5502: A reference point about expedited hearings issues.
5814: Indicates that you have the right to seek penalties in case there's an unreasonable delay in your treatment or benefits.
5813: States that if there's any bad faith or frivolous conduct on the part of a party, the judge can order penalties and sanctions.
4. Should I Rush into Court?
We suggest you try and resolve the issue with the insurance company before you reach court. The judge will want to see that you attempted to negotiate with them first. And if you really can’t solve it through negotiating, go ahead and request penalties and sanctions in court.
Moreover, insurance companies prefer to resolve the disputed issues and the sanctions and penalties through a C&R settlement because they don’t want to have a mark on their record.
Pursuing penalties and sanctions might not be easy, but in some cases, you need it to get the treatment and payments you are entitled to. You must verify there’s a valid reason and try to resolve it with the insurance company first. If that doesn’t work, you can go to the WCAB and start the process as explained above.
It is an intricate proceeding. Thus, even though you could do it yourself, you will get better results with professional help. If you find yourself in this situation, talk to us for free at 800-606-6999.
Pacific Workers', The Lawyers for Injured Workers in Northern California's Premier Workers' Compensation Law Firm. Representing First Responders, Health Care Workers, Construction Workers, Delivery Workers, Warehouse Workers, and all the hard-working people that keep our community moving in their Fight for Justice against the Insurance Companies.
With over 250+ Five Star Reviews; an incredible staff of caring, well-trained, advanced technology for superior client communication: a track record of an over 98%-win rate and giving back to our community through the Pacific Workers' Foundation, it is easy to see why Pacific Workers' is the go-to law firm for all injured workers in Northern California. Offices in Oakland, Concord, Stockton, Tracy, San Jose, and Sacramento.
If you or a loved one need help or just have a question, give us a call at 800-606-6999 or email us at Intakes@pacificworkers.com.