Duty to investigate

We see it everyday; a client calls our office after a work accident that was summarily denied by the insurance company. They were never contacted for a statement, their employer doesn’t want to talk to them, and the carrier is ignoring their calls.  The client is injured, can’t get medical treatment, and out of work!

California law requires that Injured Workers be treated fairly. Regulation 10109 section (e) provides that “Insurers, self-insured employers and third-party administrators shall deal fairly and in good faith with all claimants…. ”.   Further, this section 10109(d) provides that “[t]he claims administrator must document in its claim file the investigatory acts undertaken and the information obtained as a result of the investigation. This documentation shall be retained in the claim file and available for audit review.” This section requires documentation so that outside bodies can investigate whether the file was handled properly.

In other words, insurance companies have a duty to investigate accidents and have a factual or medical basis for denying those claims. Failure to do so can result in penalties, sanctions, and even civil liability.

Borrego law has a decades long track record of fighting unjust denials and winning our clients the treatment and benefits they deserve.

Call us for a free consult.

José Borrego

Attorney

(916) 446-4911

Joseborregolaw.com