What Happens if the Insurance Company Does Not Pay My Weekly Benefits?

PENALTY BENEFITS

If the employer or insurance carrier denies, delays, or terminates weekly benefits without reasonable cause or excuse penalty benefits may be awarded.  Penalty benefits may be up to 50% of the weekly benefits which were improperly denied, delayed or terminated. 

To be considered reasonable cause or excuse the employer shall satisfy all of the following criteria:
  1. The excuse was preceded by a reasonable investigation and evaluation by the employer or insurance carrier into whether benefits were owed to the employee.
  2. The results of the reasonable investigation and evaluation were the actual basis upon which the employer or insurance carrier relied upon to deny, delay, or terminate benefits.
  3. The employer or insurance carrier contemporaneously conveyed the basis for the denial, delay, or termination of benefits to the employee at the time of the denial, delay, or termination of benefits.
Penalty benefits DO NOT apply to unpaid or delayed medical benefits.
 
INTEREST

Interest is due on delayed or unpaid benefits regardless of whether the delay was unreasonable.  Interest is due on unpaid or delayed benefits regardless of the reason. 
 
ADVICE FOR CLAIMANTS

If weekly benefit checks are being sent directly to the claimant, he/she should copy both the check and the envelope it was sent in and save them.  Additionally, claimants should document in a spreadsheet:
  • The dates the weekly benefit check was intended to cover
  • The amount of the check
  • The date the check was cut
  • The date the check was mailed
  • The date the check was received
  • The date the check was due
This spreadsheet, along with the copies of checks and envelopes should be turned over to your attorney.
Anytime a client has their benefit checks sent to our office, we document all this, and more, for them before we issue the check to the client.