Workers’ Comp insurance carriers liable for unreasonable delays or bad faith ? Workers Comp Attorney

Hi guys, my name is michael burgess, not an attorney. I wanted to touch bases really quick and I just got back from court and I want to educate my youtube videos or those people out in on the Internet, as in regards to a little bit about penalties under California workers compensation. In my personal opinion, there is a lot of bad stuff going on in California workers compensation, particularly with the insured failing to do what they’re legally obligated to do. So I just wanted to briefly articulate some of the the ammunition that we have to fight against some of the, in my opinion, insurance, bad faith, actions or inactions. So first I want to touch bases on a rule and regulation that hardly any attorneys know or argue about, and I’m not quite sure why? Because it is one of the biggest swords that we have as a advocate for California injured workers, and that is room rag1, oh 109. Essentially, what this is is this is a it’s codifying the insurance company’s legal obligation and they have a legal obligation to actively investigate to determine what, if any, benefits are due and then actively provide those benefits. So if you’re injured and the injury arose out of, it was within the course and scope of your employment and you file a worker’s. Comp claim that’s just a claim for benefits through the insurance policy that insurance company is legally obligated to investigate your claim and then actively provide benefits to you. Although in my experience you usually get a lot of passive neglect, they’ll either deny your case or if they accept their case, they don’t actively investigate to see what benefits are needed, meaning, maybe your injury is not just orthopedic. Maybe it has internal complications is causing stress, depression and anxiety, and you need to be referred out to other doctors to get treated. Maybe your your injury is catastrophic. Maybe it requires home health benefits or home modifications and the insurance company under rule in red 101. Oh nine is legally obligated to investigate and actively provide care midway through a case if they’re, put on notice that a specific benefit is needed where referrals need it or that home care is needed. They’re supposed to investigate and accurately provide these benefits. Remember rule and reg 101. Oh nine! This is a very big provision in the labor code and all you applicant attorneys. You should really be looking at this because it’s codifying what the the workers comp insurance is legally obligated to do. Now I take the position that, if they fail to adhere to their legal obligation, if they fail to investigate, if they’re, put on notice of something and they fail to investigate where they fail to actively do what they’re legally obligated to do. It gives grounds for penalties. Now there are a few penalties on a touch basis when it’s called 4650 d. This is really if the insurance company catches, something they’re doing incorrectly, like paying you a late, temporary disability payment or a late payment of something they can do a ten percent self imposed penalty, but keep in mind this is when the insurance company catches that They messed up and they can do a ten percent self imposed penalty, although this is largely not going to be discussed because, frankly, those are not the penalty provisions, I would focus on. You have Labor Code 5814 and labor code. 58. 14. 5, labor code, 58. Fourteen is penalties for unreasonable delay, so this is where an attorney can show that the defendants actions were unreasonable and that has delayed benefits to the injured worker. So remember, if you’re utilizing rumah reg 101, oh nine, they have a duty to investigate and actively provide benefits. If you can show that they had sufficient knowledge that triggered their legal obligations to invest in actively provide benefits, and they fail to do so and that this failure provided a unreasonable delay in benefits, then you can get penalties under Labor Code 5814. Really, the penalties are up to a twenty up to twenty five percent penalty, but not to exceed ten thousand dollars. So essentially, if there’s an unreasonable delay in anything – and you can point out to the court and the workers comp appeal board – judge determines there’s an unreasonable delay that you can get awarded up to twenty five percent penalty up to ten thousand dollars. Maximum now you can also potentially bifurcate these into several potential unreasonable delays, and then it’s really up to the jurisdiction and discretion of the court. Keep in mind that penalties cannot be awarded unless there’s a petition, a penalty petition. You have to give the defendant due process a chance to investigate and respond before a worker’s comp appeal board judge, can award penalties now labor code, 58, 14 5 can award an additional attorney fees if you’re enforcing an order or an award. So if the defendant has been ordered or the applicant has been awarded, something and the defendant fails to pay it timely and that’s been determined to be an unreasonable delay. Then, in addition to the twenty five percent penalty, or up to 10 000, you can also get a statutory attorney fees under fifty eight 14. 5. Finally, you have Labor Code 5813. This is for bad faith actions. So if you can never show that a defendant,’s, action or inaction is tantamount to a willful disregard for their statutory or legal obligations and is essentially a bad faith. Then you can get additional penalties under labor code 5813, which includes the twenty five percent increase, which also includes statutory attorney fees, even if there isn’t a award and order. So if you guys are out there and think that the these workers comp ensures are just willfully, disregarding their legal obligations and and there’s really nothing that can be done. That’s, not the case. Remember that an attorney can file a penalty petition. We can get penalties under labor code 5814, labor code, fifteen fourteen point: five labor code: 58. Thirteen, it just takes a lot of work, but remember that if we can, we can layout for the workers comp judge and show that a defendant is legally obligated to do certain things at a room, ragueneau 109 and they’re willfully. Failing to do it to me that’s a per se unreasonable delay, if you can show that you’ve, put them on notice and they’ve continually failed to do what they’re supposed to that’s, bad faith. In my opinion, okay and and if you guys are out there, this is happening to you. You really need an attorney who’s going to advocate, for you spend the time to draft the penalty petition, which is a very tedious and litigate hope. This has been helpful if you guys have any questions or concerns feel free to give us a call Music