Legal Question in Workers Comp in California

My workers compensation claim was denied in bad faith. The adjuster ignored medical records and first report of injury and denied a lumbar injury. The reason was due to a good faith personal action from employer. The adjuster only spoke to employer during the investigation and ignored getting statements from witness. How can I get the claim accepted other then going the long appeals process.


Asked on 9/19/18, 12:39 am

1 Answer from Attorneys

Nancy Wallace Nancy Wallace Atty at Law

There is no fast, simple way to force an insurance company to 'accept' responsibility for a work injury. The fastest way is to get the panel of three QME doctors, research them very very very carefully, pick the very best one, get the earliest appointment with that best one, and check in with the adjuster every week to make certain the QME is getting all of the records and medical evidence he needs to evaluate you, then it is up to YOU to convince this QME doctor (along with the written medical records) that you were hurt doing your job. when you get the QME report that finds you WERE hurt as the result of employment and it was not just a 'good faith personnel action', sometimes the adjuster will voluntarily accept responsibility at that point. Without that QME report demonstrating how the injury arose out of employment and in the course of employment, the adjuster has no reason to accept responsibility. BE VERY CAREFUL: if you pick a QME 'in bed' with insurance companies and he agrees with the adjuster, that your injury is the result of the employer correcting you in good faith, then your claim is over. So pick your QME doctor wisely.

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Answered on 9/20/18, 4:55 pm


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