Q: If I was denied workers’ comp, would a California work injury settlement just pay for the costs of my medical care, or am I owed more than that?
It all depends. In cases where workers' compensation has been unfairly denied, a California work injury settlement can pay for additional costs due to lost income. And in some cases, you may seek an additional penalty as a result of unfair treatment.
Once you have been awarded your settlement for denied medical treatment, you are allowed to request that the insurance company be penalized for its unreasonable withholding of benefits. These penalties are used to discourage late payment and denials by awarding large percentages of the total lost care amount.
However, after the latest round of insurance reforms, insurance companies can only be penalized for between 10% and 25% of the value of the denied benefit (rather than the total amount of your award). How much you receive depends on the treatment you were denied. If you were compensated for casting and x-rays totaling $5,000, you could receive an extra $500. If you were awarded payment for a major surgical procedure, your penalty award could be in the thousands.
How much you could ultimately receive for your injury depends on the specific factors in your case: when you were injured, what you were denied, what treatment you had and will have in the future, and how you are expected to recover. One thing is certain: You will have to speak up in order to get what you need—even if that means hiring an attorney to do it for you.
The Ledgerwood Law Group can tell you what to expect from a workers' comp case in our book, The Northern California Workers’ Compensation Survival Manual. Click the link on this page to order your FREE copy, or call 888-761-7383 to find out how we can help you.