How is the Insurance Company Penalized if my Weekly Wage Payments are Late?
The insurance company bears the burden of delivering temporary total disability (weekly wage) payments to you. If the postmark on the envelope shows that the payment was mailed late, you are entitled to an automatic penalty payment equal to 15% of your check (this penalty is 20% if your benefits were not started voluntarily by the insurance company and the State Board had to intervene).
While the insurance company cannot avoid penalty by claiming that your check was “lost in the mail,” you do have a responsibility to provide the insurance company with a valid mailing address. If you have or can get a post office box, we will have a much easier time proving that you did not receive your mail.
Why Would the Insurance Company Deny my Legitimate Claim and Pay Late Fees?
Every so often, I represent a client who clearly has a legitimate claim but receives a denial notice stating that his benefits are being “controverted.” The law gives insurance companies 21 days to initially investigate and decide whether to pay and up to 81 days to investigate for ”new evidence.” Workers’’ comp insurance companies are very careful about commencing benefits because it is expensive and time consuming for them to cut you off once they start paying. It is easier and cheaper to deny the claim first and ask questions later.
In my experience, insurance companies controvert otherwise legitimate claims when they think that:
- you lied on your job application about a prior injury
- there is some evidence of drug or alcohol involvement in the accident
Insurance companies controvert other claims if their investigation suggests that your injury did not occur while you were on the clock.
I get involved in cases both when benefits have been denied (or cut off), and when benefits are being paid but my client is concerned about the quality of medical treatment or about settlement.