The California Division of Workers’ Compensation (DWC) provides a de for individuals to file a complaint against a workers’ compensation adjuster or administrator.
It’s called the Audit Complaint Form, and it can be used for complaints regarding:
- Late disability payments
- Denial of liability
- Failure to pay for treatments
- Failure to investigate a claim
Filing a complaint against a workers’ compensation adjuster will not resolve any issues regarding your claim. Rather, it helps the DWC Audit & Enforcement Unit regulate its employees’ conduct. If you have a problem with your case, contact the team at KJT Grupo de Derecho for more information. During a free case review, you can learn about partnering with a abogado de compensación de trabajadores.
The Process of Filing a Complaint Against a Workers’ Compensation Adjuster
Many people opt to use form DWC-AU-906 when filing a grievance about a workers’ compensation claims adjuster. However, based on the nature of your complaint, you may forgo this form and create your own. In that instance, you must include the following information:
- The claims adjuster’s company name, address, and phone number
- Your name, address, and phone number
- Your claim number and the date of your injury
- The name of your employer
- Your Workers’ Compensation Appeals Board case number (if you have one)
You should also include any supporting documents, which may include emails and other forms of written correspondence.
Where Do I Send My Complaint?
You mail the complaint if it is more than 50 pages to:
DWC Audit & Enforcement Unit
Attn: Complaint Desk
160 Promenade Circle, Suite 340
Sacramento, CA 95834
If the complaint is 50 pages or less, you can email it to firstname.lastname@example.org. You will not learn the details of your complaint if it’s audited by the DWC. A complaint in this instance is for “the greater good” and helps the DWC regulate its employees and ensure a smooth claims process. You will not know if the claims adjuster gets terminated or penalized.
Are Workers’ Compensation Complaints Confidential?
It depends. When you submit your complaint, you have these options:
- Keeping it confidential. If you mark your complaint as confidential, the Audit Unit will not share the complaint with anyone named in the report. There is also the chance that if you flag your complaint as confidential, the Audit Unit may not review it.
- Making it non-confidential. In that instance, the Audit Unit could share the details of your complaint with the involved parties.
You are protected from retaliation, and filing a complaint should have no effect on your benefits––whether that means keeping them or getting them in the first place.
Examples of Complaints Against Workers’ Compensation Adjusters
You have the right to file a complaint against the adjuster working on your claim. Such complaints often address the following problems:
- The adjuster is slow to complete each step of the claims process. As a person with an injury, illness, or condition, you need financial support to recover or, if you are now disabled, adapt to your new reality.
- The claim was unfairly denied, forcing you to appeal the decision, which delays a settlement.
- The benefits are consistently late, the wrong amount, or do not arrive at all.
- The adjuster continually ignores your physician’s treatment plan, denies needed services, or insists you return to work against your doctor’s advice.
- Your case is shuffled from adjuster to adjuster, delaying your claim.
- The adjuster does not return attempts at communication.
- You were not provided with a list of physicians recognized by the insurance company and did not receive care from a specialist.
- You did not receive or were not made aware of all the various types of benefits available through the insurance policy.
What Happens if the Claims Adjuster Denies My Workers’ Compensation Claim?
If the claims adjuster denies your claim, filing a complaint will not yield the benefits you want. Instead, you must file an appeal with the California DWC and go through that process. This requires filling out and submitting a Petition for Reconsideration and asking a judge to rule on the decision.
Some reasons why you may request reconsideration include:
- The DWC board did not act within its powers.
- The DWC’s decision was influenced by fraud.
- The evidence in your case did not support the decision made.
- You have new evidence to support your case.
Navigating the workers’ compensation process can get complicated without a lawyer’s help. That’s where KJT Law Group comes in. A lawyer from our firm can advocate for you after a workers’ compensation denial. We fight for the benefits you need and deserve after suffering an on-the-job impairment.
What You Can Expect From a Workers’ Compensation Lawyer
In addition to helping you file a possible complaint against a workers’ compensation adjuster, your lawyer can also:
- Investigate the on-the-job incident and gather evidence
- Consult with your healthcare team
- Review the details of your diagnosis
- Determine whether a third party’s negligence led to your injury
- Manage communications with the involved parties
- File your case’s required paperwork and review it for accuracy
- File an appeal, if necessary
- Offer support on a contingency-fee-basis
- Keep you updated on your case’s progression
- Answer your questions as they arise
You may find that dealing with the workers’ compensation adjuster becomes easier once you hire a lawyer. That’s because, with your best interests in mind, they pursue what you need. They combat any allegations that could discredit your case or result in fewer benefits than you deserve.
KJT Law Group Advocates for Workers’ Compensation Claimants
Our workers’ compensation attorneys understand the laws in California that affect your rights as an injured employee––whether you work seasonally, part-time, or full-time. We help you receive the benefits appropriate to your claim and protect your rights while working with the adjuster assigned to your case.