Insurance companies use a number of underhanded techniques to try to stall your claim. Here are some unscrupulous behaviors to look for that suggest your insurer isn’t acting with your best interests in mind.

1. Requesting You Record a Statement

Some workers’ comp claims adjusters request recorded statements or even try to make you believe recording your statement is mandatory to proceed with your claim.

The problem is that recording a statement helps the insurer, not you. The insurance company can carefully review the tape and compare it against future statements to catch inconsistencies.

These discrepancies are often innocent and explainable. For example, you may have been in pain and not fully coherent, or you may not have understood the extent of your injury initially. However, insurers can still try to use them to “prove” that you aren’t acting honestly or that you’re exaggerating the extent of your damage.

Don’t make a recorded statement without talking to a lawyer first. There is no upside and lots of potential downside.

2. Creating Procedural Obstacles

Some insurance companies aim to overwhelm you with paperwork and pointless requests, making it difficult for you to keep tabs on your claim and giving them an excuse not to give you benefits.

This tactic could involve repeatedly requesting unnecessary medical documentation from you, sending you unnecessary forms to fill out or asking you to fill out the same forms multiple times. Or on the flip side, your company may be slow to provide you with the forms you need to complete or might not be upfront about what documents you’ll have to submit so the insurer can process your claim.

Be sure to submit written requests for information and keep copies of every form you submit.

3. Failure To Communicate

You’ll need to be in regular contact with the insurance adjuster so you can complete your benefits application, provide any necessary information and receive the compensation you’re entitled to.

Unfortunately, sometimes adjusters intentionally try to dodge your calls, are slow to answer emails and otherwise fail to communicate with you. This could result in missing important claim deadlines or making it more difficult to gather the evidence you need to get your claim approved.

Document any attempts to communicate and consistently reach out via multiple channels, including phone and email.

4. Disputing Your Injuries

Workers’ comp insurers may argue you aren’t hurt as badly as you claim or that your injuries were pre-existing.

They might try to force you to see multiple doctors they chose, who have an allegiance to the insurer since the insurance company is sending them patients and paying the bills. Or they may call your doctor with “follow-up” questions, designed to try to find inconsistencies in their statements or discredit their diagnosis.

Understand your rights, including when and if you are allowed to choose your own doctor. Document every symptom, report everything to your doctor and be sure that you have detailed medical records.

5. Failing To Authorize Treatment

Sometimes, adjusters will try to argue that some specific type of treatment is unnecessary or not covered. This can result in an inability to get the care that you need.

Keep records of denials, and be sure your doctor has kept clear records of recommendations and symptoms indicating a particular treatment is needed.

6. Urging an Early Return to Work

The insurer might try to urge you to return to work before you are ready or may try to convince you to accept light-duty work as soon as possible.

While it may be tempting to accept light-duty work to have income coming in, this could backfire. The insurer could use it as evidence that you aren’t as badly hurt as you claim. Working before you fully recover could also worsen your injuries over the long term.

Do not return to work in any capacity before your doctor clears you and before you feel truly prepared.

7. Failing To Pay Your Medical Bills on Time

Finally, insurers sometimes don’t pay medical bills or delay paying them for a long period, often while claiming they are awaiting authorization.

Keep copies of your bills and document your attempts to get them paid.

Categorized in:

workers compensation,

Last Update: June 24, 2024

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