Tricks Insurance Companies Play To Deny Your Case


Don’t fight your DBA case alone.



As part of our awareness campaign, we are pointing out some common tricks insurance companies use to deny your DBA case. Watch out for these signs, if you see any of them, it is time to talk to an experienced lawyer.

No. 1: Nurse Case Manager

I’ve had clients say that they didn’t get an attorney until they called me because the Nurse Case Manager said that she was going to take care of everything. Or the Insurance Adjuster said, “Hey, once you get back home you’ll be treated like a king…blah blah blah.”

The thing you should be aware of just practically speaking is that every time an insurance company does something, they’re doing something to try to minimize your claim.

Why would they require a recorded statement from you if they request one? They are already aware of what occurred.

Insurance companies try to find something that they can use against you in the future.

It’s the only reason that they would want a recorded statement from you. They have witnesses, they have the company who knows what happened to you, and what the injury was.

No. 2: Beware of Independent Medical Exam

Second, why would they send you to an Independent Medical Examination with a doctor of their choosing? Wouldn’t that imply that they’re attempting to avoid relying on your treating physician? You have the right to select any doctor you like. So go ahead and do it.

That’s probably the only purpose for sending you to an Independent Medical Examination so they can get away with not having to pay for your medical care.

No. 3: Vocational Assessments!

Third thing, they do a Vocational Assessment. What is a Vocational Assessment?

Someone from the insurance company interviews you about all of your qualifications. He asks about all the things that you could possibly do physically even though you could be partially or pretty much permanently disabled.

Will they be doing this Vocational Assessment to find jobs for you to help you get back on your feet? No! They’re doing it to find a job you can do so they can cut your benefits off.

What’s an Independent Medical Examiner?

They’re trying to find jobs they think they can qualify you to do. They will send those job qualifications and physical requirements to their Independent Medical Examiner or Peer Review. He’ll then sign off, saying, “Yeah, we can probably show a judge that he or she can do these jobs.”

Well, that obviously will reduce the benefits that they pay and that’s the only reason they do it.

An Independent Medical Examiner is any doctor who is hired by your insurance company to evaluate you. They can suggest you’re ready to return to work, that you’re faking symptoms, or that you’re making everything up, and that your doctor’s care is unnecessary. This is when you will require the services of a Defense Base Act Lawyer.

What is a Peer Review?

A Peer Review is much worse: the insurance company takes all the documentation without even seeing or reviewing you in person. An insurance business employee is employed to say, “OK, let’s cut the benefits, he’s fine.” Based on what I observe here, he does not require surgery, and we should get him back to work.”

You will need a lawyer to combat this when this occurs. Watch this useful video.

So, because it costs nothing to speak with a Defense Base Act lawyer, and no one will call to sign you up, you have the right to ask any question you want about your case, about your situation.

Maybe you’re just out of the military. You’ve done your tours and you’re just taking your first job as a civilian contractor. The best thing you can do for yourself is to first get on the phone with a Defense Base Act lawyer.

Then, obtain the form so you can select your physician and download the LS-1 Form from the website. It’s the First Choice Doctor Form, which you fill out before going overseas. Add it on your checklist, then keep one for yourself and one for your family. When you are injured, send a copy to your employer. Keep it with you and make a list of all the specialists you could require back home in the United States or in your home country.

Do a search for a neurologist, a psychologist, an orthopedic specialist, a PTSD doctor, or any doctor you want to treat you should something occur that’s out of your control. We don’t like to think of the worst-case scenario, but you can be prepared.

What is a Labor Market Survey?

They don’t do it for your benefit. After the Vocational Assessment, there’s what’s called a Labor Market Survey done on you. And that they try to search for and find jobs that pay enough money that it will affect your bottom line as to what your compensation rate should be in the future.

In other words, they try to qualify you to do a job so they can cut you off.

When they find you a job, they conduct a Labor Market Survey. You may be a translator, yet you suffer from PTSD. They’ll scour the labor market for any employment, no matter how menial, physical, or irrelevant to you, and most likely below your level of ability and salary. They examine your physical capacity and tell the judge, “he can do this job,” in order to reduce or eliminate your benefits.

They one time told a client that he could work in horse racing as a handicapper. That’s how hard they work to find you a job. But when you have an attorney to fight for you, you’ll be able to fight it with the truth. You’re not left to hang out and figure out how you’re supposed to take the ridiculous jobs they suggest.

What is a Functional Capacity Evaluation?

They want you to go to a Functional Capacity Evaluation. They’re looking for exaggeration, they’re looking for any type of thing that they can think of to say that you’re not trying your best, doing exercises and doing these different bending and lifting things that you may or may not be able to do.

And they only simply do the Functional Capacity Evaluation to try to get you back into the workforce under their terms and not under your or your doctor’s terms. So be aware of the Functional Capacity Evaluation as well.

They Will Do Surveillance on You

Finally, a lot of times if the case is real and it looks like long-term care is going to be needed, including possible surgery, it’s not uncommon for the insurance company to do surveillance on you.

Other Tricks: Questioning Your Statements

And it’s just another tool in their arsenal to try to catch you off guard and force you to explain yourself during an initial written statement or oral statement that they may ask you for in a deposition if you’re not represented. They’ll twist your words and say things like, “You acted like you couldn’t do anything, and we saw you in your yard cutting your grass, picking up your kids…blah blah blah,” and then try to persuade the judge that you’re untrustworthy.

So those are all the things that the insurance companies do to people regardless of you individually because you’re just simply a number to them and they want to try to minimize the number that they’re going to have to pay you.

Don’t Fight Alone: You Don’t Have To

We have a 24-hour line (+1) 800-393-2999 available for you to call us at any time. Alternatively, you can visit our site or find us on most social media platforms.

Alternatively, you can use the form below to contact us.

If you are injured on duty and even before you are deployed overseas, you can always contact Garfinkel Schwartz Law Firm and send us your questions. We will get back to you as soon as possible.

Please call our 24/7 number (+1) 800-393-2999 or use the following form to get in touch with us.