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Beware Tricks Insurers Use to Deny Claims

Hi. This is Brian Wiklendt with Garfinkel Schwartz. I’m coming to you from our Maitland Florida office, which is a suburb of Orlando. I’m lead counsel here. What I’d like to do is talk to you a little bit about what insurance companies try to do under the Defense Base Act to get away with not paying on claims.

Beware Tricks Insurers Use to Deny Claims

There are a lot of different things that insurers do to reduce the cost of an injury claim. We want you to beware tricks insurers use to deny claims. It’s really tough to go alone if you don’t know these tricks and you don’t have an attorney that specializes in the Defense Base Act.

First Trick – Deny the Claim

First, they try to deny the claim. That’s the first thing that they’re always going to try to do is deny the claim. They do that in various different ways. Let’s talk about the tactics they use.

Did you Give Adequate Notice

First, they’re going to talk about notice. Did you did you give adequate notice to your employer? If you don’t know what the Defense Base Act is, it’s difficult to know what you have to do and you have to rely on the employer to go through the correct process. So, as soon as you get injured you want to talk to the human resources people or your supervisor and say how do I do this claim formally. How do I actually get the Department of Labor to understand and know that I have a claim here? That’s one thing that they try to do.

Remember Their Doctor Works for Them

tricks insurers use to deny claimsNext, they try to deny claims based on hiring a person that would be say a nurse case manager or someone that’s going to try to get you treatment. And they’re working for the insurance company not you. They’re supposedly helping you get the treatment that you need and monitoring your medical care so that they can provide it for you but a lot of the time they’re actually trying to find ways to figure out whether this is actually work related, whether it’s pre-existing, whether it’s degenerative disc disease instead of an actual traumatic injury.

They’re always trying to put holes into the true nature of your injury is. And so, you want to be aware of that. You want to talk to a lawyer about that. You want to see how you should interact with these people that are hired by the insurance company to give medical advice and medical treatment when they may or they may not be qualified to do so.

Talk to an Attorney before Giving Recorded Statement

They also try to deny claims based on an initial recorded statement. They want to send someone out very quickly as fast as they can to try to get a recorded statement from you. They try to get you to do this without the aid of an attorney or you knowing any of your legal rights. I would suggest that if they’re asking for that, you call an attorney right away. You could always call our office it’s free. I can give advice on that as to what you should watch out for in a recorded statement.

You May be Under Surveillance

They also do surveillance to try to deny the claim to say that you’re somehow being dishonest and you’re not really as injured as you say you are which could be an outright denial if the judge or someone believed that you were exaggerating or basically flat out misrepresenting what you can and can’t do under the surveillance.

Insurers Also Try to Reduce Payments

After they try as hard as they can to deny claims once they have to start paying on the claims that’s a whole other ball of wax. Now they’re going to try to reduce whatever they have to pay whether that be medical treatment that they’re going to claim is unnecessary.

Your Right to Choose Your Own Doctor

You have the right to choose your own doctor. If someone recommends surgery, you should have a medical opinion regarding why that is so and how they came to that resolution so that they can’t fight with an independent medical examiner, which is what they do in that circumstance. And they try to find a doctor that’s an independent medical examiner that they hire and pay to get a favorable medical result for them – meaning that the surgery’s unnecessary, maybe injections are unnecessary, that kind of thing, to try to avoid paying for the correct medical treatment.

Be Wary of Returning to Work Too Soon

After that, it still goes on and on. They’re going to try to reduce your benefits based on what’s called a labor market survey. Once you get back on your feet, they’re going to try to find jobs around your area that you’re qualified to do, that they claim that you’re qualified to do, that you can also physically or mentally do as well. A lot of those times we believe that those jobs, some of those jobs or maybe all those jobs, are completely inappropriate for what you can do actually physically or mentally based on the state that you’re in.

Another Trick Insurers Use

They try to find obviously the most expensive jobs so they can try to reduce your weekly average compensation benefits. And they’ll try to do that throughout time. They’ll keep trying every six months to a year. They’ll send you to an independent medical examiner or they’ll do another labor market survey trying to find jobs that they can prove to a judge that you can do even though you don’t think you can do them. So, you want to make sure you have a lawyer. Someone that knows how to fight against those types of things.

Beware of Physical Exams before You are Ready

They also have functional capacity exams that they give you to try to get you to exert yourself so that they can say that you’re actually more healthy than you are. That you can lift up to a certain number of pounds, that you can bend over, that you can crouch, that you can lift your arms over your head when maybe you can’t. That’s called a functional capacity evaluation. They use all these things hand in hand to try to get you back on your feet maybe faster or forever in terms of reducing whatever their exposure is on your claim.

They Will Not Give Up

And like I said, they have a vast resource of knowledge, experience, people and money to just constantly and continuously try to reduce your benefits. So, it’s just not worth it in my opinion to go about this alone. Sooner or later they’re going to use one of these tricks to deny claims, regardless of whether you think they’re doing the right thing or not. Sooner or later they will. It’s just in their nature.

Seek Advice and Understand Your Rights

So again, call me anytime it’s free. 24 hours a day, we have an answering service and I can get back to you or someone here can get back to you and give you the advice that you may need. Again, it’s always free to contact the office and ask some questions. If you when you hire an attorney, me for instance for example, you wouldn’t have to pay me. If I get benefits for you, I get paid directly separately from the insurance company based on my hourly rate.

So, if you have any questions regarding this or if you are in the process and you are a Defense Base Act claimant and these things may or may not be happening to you it’s always worth it to get knowledge so that you have enough knowledge to fight against the insurance company.