If you are a Defense Base Act claimant, it is always good to have more knowledge. This will better enable you in your fight against the insurance company.
This is Brian Wiklendt with Garfinkel Schwartz and I am talking about the tricks insurance companies play to deny your case.
First, the insurance company will try to deny the claim. They do this in a variety of different ways. Let’s talk about the tactics they use.
The insurance companies will look to see if you gave your employer proper notice of your injury(ies). It’s tough to know what to do if you don’t understand the Defense Base Act. You must rely on your employer to follow the proper procedures. As soon as you are hurt, you should speak with human resources or your supervisor about how to file a formal claim.
The insurance companies will hire medical providers seeking to provide you treatment. These medical providers are working for the insurance companies – not you. They are supposed to be monitoring your medical care so that they can provide it for you, however, often they are trying to put holes into the true nature of your injury. You need to be aware of that and should speak with a lawyer before interacting with medical providers provided by the insurance companies.
The insurance companies will try to deny claims based on an initial recorded statement. They will send someone out as fast as they can to try to get a recorded statement from you. They will try to get you to provide a recorded statement without the aid of an attorney, and prior to you knowing your legal rights. Prior to providing a recorded statement, you should consult with an attorney.
The insurance companies may conduct surveillance to try to deny the claim. They might say that you’re somehow being dishonest and that you are not as injured as you claim to be. This could result in an outright denial of your claim if a judge finds that you exaggerated or misrepresented the nature and extent of your injuries.
After attempting to deny your claim, insurance companies will then try to reduce whatever they have to pay. For example, they may argue that certain medical treatment is unnecessary. These are some of the tricks insurance companies use to deny your case.
The insurance companies will hire an independent medical examiner. This medical examiner will likely seek an outcome favorable to the insurance company. However, you have the right to choose your own doctor. In this case, you should consult with a doctor of your choosing and obtain a medical opinion regarding why a certain course of treatment is necessary.
The insurance companies will try to reduce your benefits based on what’s called a labor market survey. They will try to find jobs around your area that they feel you are qualified to do – both mentally and physically. Many times, those jobs are completely inappropriate for what you are capable of performing.
The insurance companies will try to reduce your weekly average compensation payments by finding the highest paying jobs available. Every six months to a year, the insurance companies will conduct another labor market survey or send you to an independent medical examiner. They will attempt to show a judge that you are capable of performing certain jobs when, in fact, you are not. So, you want to make sure you have a lawyer. Someone that knows how to fight against those types of things.
The insurance companies may also conduct functional capacity exams. Functional capacity exams are designed to measure your physical ability to perform certain tasks (i.e. lifting heavy objects, bending over, lifting your hands over your head or ability to crouch). They use their findings to reduce their exposure on your claim by attempting to show that you are capable of performing certain jobs when, in fact, you are not.
The insurance companies have a vast resource of knowledge, experience, people, and money. They will constantly and continuously try to reduce your benefits. Sooner or later, they’re going to use one of these tricks to deny, or reduce, your claim, regardless of whether you think they’re doing the right thing. It’s just in their nature.
Contact the team at Garfinkel Schwartz to discuss your matter further. The call is free and you will speak directly with a member of our team. If you retain us, your legal fees are paid by the insurance company.