After a work injury caused by a single incident or work activities over time, employers and their insurance carriers sometimes drag their feet, assert a causation defense, pressure an injured worker and treating doctors, or find other ways to minimize a claim. However, there are things you can do to protect yourself. If you were hurt on the job and your benefits were denied or you believe you may not be able to return to your prior occupation, the team of worker’s compensation attorneys at Kingree Law Firm can help.
Like all insurers, worker’s compensation insurance companies make a profit by approving fewer claims and paying less on the claims they do pay. When an insurance company denies a claim for worker’s comp benefits, it avoids paying for the employee’s medical bills, lost wages, or permanent disability. On the claims they do pay, insurance companies have tools to limit their exposure, such as hiring so-called independent medical examiners to challenge the claimed severity of the worker’s injuries, attributing the employee's injuries to pre-existing conditions, or pushing a worker to return to work before they are able.
Delay is another tool insurance companies use to reduce payouts, even on claims that are ultimately paid. A worker who is out of work with medical bills piling up and no timely payment of wage loss benefits may look for another job or return to work sooner than their doctor recommends. This can reduce or eliminate the wage loss benefits the insurance company may otherwise pay. In some instances, injured workers return to work beyond their physical capabilities, resulting in reinjury or worsening of their medical condition.
A worker who was injured on the job should know the tactics insurance companies use to deny legitimate claims or reduce their value.
After a workplace injury, you want answers to your questions and to receive the compensation you deserve as quickly as possible. However, you’re not the insurance company’s client—your employer is. The claim adjuster has no incentive to respond promptly to your questions or provide quality customer service to you. In fact, it’s sometimes the exact opposite. The claims adjuster may delay responding to your call or emails, hoping you will give up or cave to their pressure when they eventually get back to you.
Many claims adjusters insist on a recorded statement. If you have been telling the truth, you may think you have nothing to hide. But adjusters can take your words out of context and use them to benefit the insurance company. For example, when the adjuster asks, “How are you?” you might reflexively say, “I’m fine.” This response can be taken out of context and used to make it seem like your injuries are less serious than they really are. In addition, even the best among us can make small mistakes in describing what happened. Small errors, nuances in how you phrase your answer, or failing to provide all the necessary details and information, could hurt your claim. If you do a recorded statement, be brief, be clear, be consistent, only state what you know, and don’t speculate.
A claims adjuster may pressure you to sign medical authorization forms shortly after your injury, telling you they are necessary to process your claim. What they don’t tell you is that Wisconsin law entitles the insurer to obtain your injury-related medical records without an authorization. HIPAA (the Federal medical privacy law) does not apply to doctor-patient confidentiality for injury-related medical records when someone claims a work injury. Signing a blanket medical authorization could allow the claims adjuster to access your entire medical history, which can lead to problems. The adjuster can then look for pre-existing conditions or other evidence they can use to deny or reduce your claim.
The claims adjuster may challenge your claim by asserting you are not entitled to certain benefits, that you no longer need certain medical care after a limited number of doctor visits, or that you need to seek a certain type of medical care. However, you have the right to see your own doctor and the insurance company does not have the right to dictate your medical care. You are also entitled to a second opinion without a referral from your existing doctors, but you can only do that once during your claim.
Claims adjusters understand that injured workers often face financial stress after a workplace injury. However, Wisconsin’s worker’s compensation law provides that if you miss work or have wage loss due to a light duty assignment, the insurance company must either pay you benefits or set up an examination with their “Independent Medical Examiner” or “IME” within 30 days after the insurer is made aware of the claim.
Claims adjusters are not on your side. They have no legal duty to inform you of your rights. They may intentionally withhold information. They can even lie to you without legal repercussions for that lie.
Claims adjusters may continually ask for more information that they claim is required to process your claim. While some cooperation is necessary, the insurer can obtain medical information like restrictions, diagnosis, and care plans from your medical provider directly. Be clear with your doctor that they should not be influenced by the carrier’s preferred course of action on restrictions and treatment, however.
Insurance companies earn profit by denying claims and paying injured workers as little as possible. Our experienced team of worker’s compensation attorneys can level the playing field and help you recover the benefits you deserve. We have seen the tactics claims adjusters use to deny or delay claims for worker’s comp benefits, and we know how to build a case to ensure you receive full and fair compensation for your injuries.
Kingree Law Firm is a premier worker’s compensation law firm in Wisconsin. Our team of skilled and experienced worker’s compensation attorneys exclusively represents injured workers in claims for worker’s compensation benefits. We primarily represent injured workers outside the Milwaukee area and have earned a reputation as one of the top worker’s compensation law firms in the state.
If you experienced a workplace accident or suffered an occupational injury that caused significant lost time from work, permanent disability, permanent wage loss, or if your claim for worker’s compensation benefits was denied, contact Kingree Law Firm today to schedule an appointment to discuss your situation and how we can assist you.
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