Why Your Claim is Denied

Look for signs that you are likely to get denied


Why Claims Are Denied

  • If insurance companies pay claims they lose money.
  • From Day One of your injury or illness, that friendly insurance company representative is there to get you to their doctors who work for their interests.
  • The insurance company has a right to suggest doctors but you don’t have to use them so STOP!
  • You deserve the best medical care. Call a DBA lawyer because you have the right to choose the best doctor.
  • We’ve seen insurers try every trick in the book to fight and deny claims.
  • You may need medical care and benefits for the rest of your life.

Tip-Offs That a Denial May Be Coming

We always want to share with civilian contractors, sub-contractors, and longshoremen the importance of having an attorney to handle all DBA or Longshore claims.

Insurance companies will never be profitable if they’re paying you or giving you health. Their only goal is to eventually deny, deny, deny.

You may think that a lawyer will complicate matters or that it will cost you a fortune. Neither is true: all legal fees are paid and you don’t pay a penny—ever. A lawyer will protect you, protect your compensation, and your medical care.

An experienced Defense Base Act attorney will fight for your case. Your attorney will help you complete paperwork, will prepare you for your legal meetings, and will be there to fight and defend you in court and in depositions and hearings.

Here are some words that if you hear them at any time from an insurance company should prepare you for a fight ahead. We’re not trying to scare you, we want to prepare you so that you can hold onto and keep what is yours under the law.

You have to cooperate with the insurance company’s requests so don’t ignore them. However, do not talk to them until you’ve talked to a lawyer.

Don’t go into meetings by yourself and don’t go on the record until after you’ve met with a very experienced Defense Base Act lawyer.

If you have an attorney there’s nothing to worry about because the attorney will prepare you and help you through every step.

If you’re by yourself you should not try to work anything out with the insurance company. There is no reason to try to negotiate with them. You’ll be at a disadvantage and you’ll be up against insurance companies and their lawyers.

You’re smart and you’re clever but you’re no match for some of the best insurance company attorneys in the world.

Here are the phrases to listen for so that you can be on the alert that there is a problem in the near future. Your compensation may be at risk or you may soon have a cut in your compensation. You should be clear and understand that you have to cooperate but you should not go with whatever they say.

Pay special attention to the following words

“I’m Your Nurse Case Manager” = This person works for the insurance company. It’s their job to get you back to work as quickly as possible with the least amount of cost whether it’s in your best interest or not. Money and cutting costs is the only thing that matters.

“We need a Recorded Statement” = This means the insurance company is ready to deny your claim and wants to begin by getting your statement to see if they can find a reason.

“Independent Medical Exam” = This doctor works for the insurance company and is not on you or your doctor’s side. They will try to find cheaper options to cut medical costs on your care.

“Vocational Assessment” = The insurer wants to find out what you can do physically. You’ll go through physical tests to see what you can do. The goal is to observe you from the moment that you arrive. They are watching you to see if there is any exaggeration or attempt to fake an injury or illness. The insurer often begins surveillance when you begin taking compensation. This is even more likely after this assessment is done. Do your best, be honest, and make sure that you explain what you can and can’t do physically.

“Peer Review” = A person who is not a doctor reviews your paperwork without even seeing you or talking to a doctor. Their goal here is to deny your claim.

“Labor Market Survey” = They find a job you can do, now. They’ll interview you and they’ll want to know your entire work, education, training, and medical/psychological capability. Your attorney can be with you to make sure that they don’t ask any questions that are out of line.

“Functional Capacity Evaluation” = Are you faking or exaggerating? They are watching you: Surveillance is common and they’re fast on how quickly they can catch you. You may limp one day and maybe they see you rush to your car in the rain. If your insurance provider sees this and catches it on camera it can be taken the wrong way.

“Initial Written or Oral Statement:” They grill you about statements. The only thing that you can do at this point is to call an attorney because you want to be protected and make sure that you meet with an attorney to begin telling them about your situation.

If you are injured on duty and even before you are deployed overseas, you can always contact us 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.