Why CA Workers’ Comp Investigation Timeline May Change

The length of time it takes to investigate a workers’ compensation claim varies depending on the type of injury reported, the circumstances surrounding the accident, witness availability, the extent of the medical conditions, the availability of documentation, and the cooperation and availability of all parties involved.

California bill SB 1127 would reduce the investigation period for claims in which workers have a presumption of compensability to 75 days from the employer notification of the injury. In other claims, the investigation period would remain at 90 days.

Challenges With Workers’ Comp Investigations

The California Workers’ Compensation Institute (CWCI) conducted a study that found potential problems associated with reducing claim investigation time frames; these include:

• Litigated and denied claims require significantly more time to gather reports and documentation from outside sources. Only 49.2% of litigated claims that are eventually denied have a compensability decision at 75 days.
• Employers are currently liable for up to $10,000 of medical treatment for a claimed injury during the investigation period, regardless of the insurance company’s final decision. Reducing the time frame would reduce the amount of time workers whose claims are eventually denied have to receive $10,000 worth of medical care.

How Workers’ Comp Investigations Proceed

A workers’ comp investigation looks at video surveillance, online social media channels, interviews, and medical reports to determine whether the claim should be approved or denied. The insurance company’s claims team is checking to see if the injury is fake or exaggerated if the injury is job-related, and if the employee is still working.

Investigators will watch employees coming and going from home and doctor’s offices. In addition, they will review the injured employee’s online posts, tagged photos, status updates, and other online activities. Investigators will also interview employees over the phone or in person to see if the injury is valid and work-related. Workers’ comp claims teams may also interview the injured employee’s relatives, close friends, coworkers, and neighbors to learn more about the employee and identify potential fraud.

Legitimately injured workers don’t need to worry about the claims investigations process. Hiring an experienced work injury lawyer in Orange County, CA will help ensure they have a solid case and receive the compensation they deserve. Call Thomas F. Martin, PLC today to schedule a consultation.