Legal Question in Workers Comp in California

What are penalties and sanctions worth? I have future medical. Twice now my employer has unreasonably delayed providing me treatment. One time refusing for 10 days to authorize medications that their UR certified I should have. The second time was simply my employer refused to respond to a Request for Authorization (RFA) that was faxed to them. I have documentation from the pharmacy regarding the delayed medications and I have the fax records regarding the RFA. I filed motions for penalties and sanctions and the judge has set a mandatory settlement conference which would be followed by a hearing. My employer's attorney has asked if I had a number in mind for settling the penalties and sanctions so they will not have to come back for the MSC and the hearing. I have an ironclad case to prove both incidents happened. What would be my employer's liability (total cost including sanctions, penalties, and attorney costs) if this went to a hearing and they lost? What would be a worthwhile amount to settle both violations for?


Asked on 8/17/16, 7:55 pm

1 Answer from Attorneys
Nancy Wallace Nancy Wallace Atty at Law

25% of the value of the treatment denied. If $600 of pills were unreasonably delayed, the judge can award $150. If judge finds evidence of 'bad faith tactics designed solely to delay' under LC5813, you might get another $1000.

Beware 'ironclad' cases. Unless you have the pharmacist and the pharmacy tech subpoenaed to testify at trial that they spoke personally with the adjuster and the adjuster admitted to having the physician's report and the RFA but still refused to authorize the prescriptions being filled, this may not be as 'ironclad' as you think.

Read more
Answered on 8/30/16, 1:30 pm


Related Questions & Answers

More Workers' Compensation Law questions and answers in California