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Are there penalties in CA worker's compensation cases if the carrier delays in reimbursement of out of town travel for medical
Anonymous2 views3 answers
I have submitted my reimbursement requests over and over with no response. When I do finally talk to someone, I am usually informed that I have a new carrier and am ask to start over yet again. This has gone on for more than a year.
"Carrier" is another name for insurance company. so if you have a new carrier, that means that the company you are calling is no longer taking care of your claim and there is another insurance company. the old one isn't going to pay you as they're no longer doing business on your claim.
This can happen when the real insurance company hires another company to do the paperwork or to "adjust" the claim. Sometimes they change adjusting agencies. Once that happens, the old adjusting agency turns all of the files over to the new adjusting agency and they have nothing left. If you're being told that there is a new carrier, I'm guessing that means a new adjusting agency. You need to find out who that new adjusting agency is and contact them. Call the old adjusting agency and ask who the new agency is. They'll know who they sent the files to! Also check your mail and see if you got a notification of the change.
Kenneth Michael SheppardWorkers' Compensation LawyerSan Francisco, CA ·
Under Labor Code section 4603.2(b)(2), an insurance carrier has 45 days to pay for medical treatment. If payment is not made within that time frame, the carrier subject to a 15% penalty. Reimbursement for self-procured medical expenses, including travel , are derivative of medical treatment and subject to section 4603.2(b)(2).
Additionally, Labor Code section 5814 provides for a 25% penalty for the unreasonable delay in providing benefits. You can certainly argue that the failure to reimburse travel expenses constitutes an unreasonable delay in providing benefits.
YOU'VE BEEN SHOUTING INTO THE WIND. Stop 'submitting' the mileage requests as you have (because, clearly, it's never going to work), and try two things: (1) FAXING to the adjuster's fax number with a Proof of Service Via Facsimile form (you'll need to print a fax transmission report when you're done), and (2) Mail it to the current adjuster with both a Proof of Service by Mail form complete PLUS a cover letter demanding payment by a certain date (issue it Monday? give them until June 8) or you will be demanding the WCAB Judge issue a 25% penalty. As Mr. Borah noted, the place where you sent all those demands stopped handling the claim. CHECK RECENT LETTERS OR GO ON THE INTERNET and find the correct adjuster, find her fax number, better still find her supervisor's fax number. AND HELP THE WCAB JUDGE and do all demands in writing with a proof of service. A judge can't award penalties where the worker can't prove the documents were provided. (DO NOT send anything certified..no one will sign for it...just a Proof of Service works great.)