During the workers’ compensation claims process, you may receive a “Notice of Delay.” A “Notice of Delay” usually occurs when an injury is questionable to the claims administrator or employer. Usually, if the claims administrator accepts liability for the claim and a doctor has verified your disability, they will pay for your medical treatment, medications, mileage, and temporary disability.
However, if you are receiving this document, the workers’ compensation carrier has yet to decide whether they are accepting or denying liability for your claim. Receiving this document is normal and gives the claims administrator 90 days to investigate the case; however, they can issue a decision before then. While this investigation takes place, the claim remains on delay.
While receiving this notice can be frustrating, your employer must spend up to $10,000 on medical treatment while the claim is delayed and until a decision has been made. Our attorneys always encourage our clients to apply for State Disability through the Employment Development Department while waiting for a decision, as we don’t know what the outcome of a delayed workers’ compensation claim will be.
More often than not, when you have received a “Notice of Delay,” the next step is to complete a QME evaluation which your Sacramento Workers’ Compensation attorney will request on your behalf. The QME doctor will evaluate you, but they will not take over the role of your primary treating physician. The QME’s sole purpose is to provide a Med-Legal Evaluation. The QME will review all available medical records and indicate if the injury is work-related.
Once the QME doctor establishes that your injury was work-related, the carrier would pick up liability, pay for medical treatment, and pay for benefits retroactively. Also, once the claim is picked up, the claims administrator will reimburse the Employment Development Department for the money paid to you while the claim was delayed.
However, if the claim gets denied, your employer will stop paying for medical treatment even if the $10,000 has yet to be exhausted. In this case, you will have to find a private doctor to treat your injuries, and your treatment will be billed through your medical insurance.
Do not immediately worry if you have received a “Notice of Delay.” There are many reasons why your claim may have been delayed, and one of our Sacramento Workers’ Compensation Attorneys can walk you through the whole process. Call 916-288-9193 today for a FREE consultation.