Workers’ Compensation: Coverage Issues & Arbitration

Trial  VS. Arbitration

Workers’ compensation cases can escalate quickly when an employer and an employee do not agree on whether benefits should be granted in a given case. If an employer denies benefits to an employee, the employee may opt to get an attorney to help them obtain benefits. Depending on the individual circumstances, the case could go to trial or to arbitration if there is a coverage issue.

Arbitration

Arbitration generally takes place when there is an issue of coverage. That usually means an insurance company takes the position that they have no liability to defend the case or to pay if the case is lost.  If your insurance company takes that position, it is of utmost importance to have a competent workers’ compensation defense attorney advocating for you in court.

Arbitration, in other words, is a form of alternative dispute resolution and is available to resolve workers’ compensation disputes. Across the country, there are many states that offer arbitration or mediation to resolve these claims.

Although, arbitration and mediation rarely bind in workers’ compensation. Given there are a few exceptions, if the arbitrator rules in the employer’s favor, the victim is able to appeal the decision to another administrative level in the court system.

During the arbitration, both parties, the employer and the employee, present their arguments and evidence to an arbitrator, who acts as a judge. In certain situations, there may be a panel of arbitrators, but in workers’ compensation cases, there is usually only one arbitrator. When the arbitrator hears and considers all evidence, they will issue a decision that regards the outcome of the dispute.

As attorneys, we are sometimes called upon to represent employers who dispute a workers’ compensation claim. The reason for the dispute is simple. It all comes back to money. Employers pay premiums to provide workers’ compensation benefits to workers. The premiums are affected whenever an injured employee files a claim for benefits.

Logically speaking, the more workers’ compensation claims that are filed against an employer, the higher the costs for said employer. All workers’ compensation insurance premiums will increase as more employees file for more or have an expensive claim. Due to this fact, employers, as well as insurance companies, investigate agencies in order to better monitor the victim’s daily activities.

As unfortunate as it sounds, there are employers who do not believe some injuries are serious enough or valid for workers’ compensation. Some employers may assume that an employee who files for workers’ compensation benefits is not exactly truthful. On the contrary, this doesn’t mean that every injured worker who has constant pain is dishonest. Employers can enlist help from reputable attorneys to help ease the matter objectively.

Dealing With Coverage Issues

If you have an issue with workers’ compensation coverage, we can help you navigate it. Contact us for a consultation to learn more about how you can protect your business and your livelihood against coverage issues. California state law dictates that all employers, with even a single employee, carry workers’ compensation insurance.

We Handle All Workers’ Compensation Defense Issues

At Sacks Law Group, APC, we are workers’ compensation defense specialists. We can take on every type of workers’ compensation defense case and we can offer solid legal advice to employers who want to protect their businesses. Services we provide include:

Any type of claim denial should inform all those involved in writing. The most typical reasons attorneys see a claim denied are for:

  •   Not suffering from a serious injury
  •   The injury did not take place at or during work
  •   The injured employee does not need medical treatment
  •   The injured employee does not need time off from work

As attorneys, we know the evolution of arbitration was once regulated to a select few segments of legal disputes but today is much different. There are many legal disputes that are resolved in arbitration proceedings.

In addition, there are certain considerations when choosing whether or not to appeal an arbitration. The most effective course of action to take is to consult with an experienced attorney. The emotional and financial stakes are high if one decides to continue the litigation.

Our attorneys are familiar with strict deadlines for appealing arbitration and ensure you do not lose the right to appeal. The sooner you contact us, the better chances of your case being a success. We strive to get our clients the results they deserve. Just reach out to us, tell us briefly about the claim, provide your contact information, and then choose which attorneys to contact you.

Contact Us For Assistance With Arbitration And Coverage Issues

If your company needs a workers’ compensation arbitration attorney in Los Angeles, contact Sacks Law Group, APC, for legal guidance. We can help you defend your business’s best interests during arbitration. If you are experiencing coverage issues, we can offer advice on how to best mitigate risks and get your business on the right track. We specialize in helping employers untangle legal issues related to all aspects of workers’ compensation insurance, and our history of solid results shows that we have what it takes to help you, too. Call today for a consultation.

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Employers Workers' Compensation Defense

The workers’ compensation defense attorneys at our firm know how to build a strong wall of defense around employers, protecting California employers from frivolous and fraudulent workers’ compensation claims. Sacks Law Group, APC, is skilled at working with in-state and out-of-state employers on all workers’ compensation defense issues, particularly in the areas of:

Prior to any alleged injury or accident, we also counsel employers on ways to stay compliant with the ever-evolving California workers’ compensation laws. California employers benefit from our extensive experience and strong credentials when dealing with employee workers’ compensation fraud, as well as allegations of employer workers’ compensation fraud.

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