Combating Insurance Companies In Workers’ Compensation Claims
As a Former Insurance Adjuster, I Understand the Tactics that Insurance Companies Use to Minimize Liability
Delay. Denial. Minimize injuries. Blame others. Blame the injured.
Every dollar that insurance companies can save stays in their pocket.
Before I became a lawyer, I was an insurance adjuster. Insurance adjusters are carefully trained to meticulously analyze claims, and if there is any reasonable basis for denying a claim, they do so.
Common Tactics Used By The Insurance Company To Deny Claims
In many cases, especially those in which significant damages are involved, adjusters will scrutinize claims even more carefully. Key areas in workers’ compensation claims often include the following matters:
- Ongoing treatment. Injured workers are entitled to further medical treatment only if such treatment will help improve their condition. Insurance companies will often argue that further medical treatment will not, in fact, help an injured worker.
With the help of medical experts, I make the case for injured workers as to how a particular course of treatment is beneficial to the recovery of the injured worker, and oppose efforts to discontinue necessary treatment.
- Specific types of treatment. The goal of the workers’ compensation system is to provide injured workers with treatment and income while they cannot work, and to help them regain employment as quickly as possible after an injury.
While the insurance company will naturally be interested in seeing injured employees return to work quickly, this does not always mean that they will be willing to pay for the treatments necessary to do so.
I fight for injured workers and retain medical experts when necessary to show why a particular course of treatment is necessary.
- Preexisting conditions. A particular sticking point in workers’ compensation claims is determining whether a workplace injury caused a new injury, or aggravated a previous condition, or whether a worker’s condition is solely due to a prior condition. For example, if a worker has a chronic bad back, but then further injures his back (perhaps a herniated disc) from lifting a heavy box, the worker will likely be entitled to temporary workers’ compensation benefits.
Beyond the initial injury, and as the worker’s back begins to heal, insurance companies will often try to make the argument that the worker’s back has recovered to the point where it was prior to the injury (which was still bad) in an effort to discontinue workers’ compensation benefits.
- Claims that an injury didn’t actually happen on the job. They may assert that a back injury occurred over the weekend, rather than at work on a Monday morning.
I will challenge any assertions made by the insurance company that an injury is not job-related.
- Claims that the injury is not as severe as it is. They may recognize that an injury occurred, but it wasn’t as severe as claimed by the injured person. In particular, a key aspect for many injuries concerns the degree of impairment.
I rely upon physicians and other evidence to prove the severity and limitations of a client’s injuries.