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In theory, Workers’ Compensation is supposed to offer working Americans medical care and financial security in the event that they get hurt on the job. In reality, Workers’ Compensation has turned into a for-profit industry that is selling workers nothing more than a bill of goods. The end result is long delays, expenditure saving treatments that only fix the symptoms instead of the injury, and often the complete denial of benefits.
A recent study by the Center for Justice and Democracy tells a disturbing story of the national decline of workers’ compensation due to greed, the political influence of insurance companies and a public relations onslaught based on unsubstantiated allegations instead of facts.
This report is as illuminating as it is disturbing, and sheds much needed light on the tactics used by workers’ compensation insurers to protect their profit margins while severely short-changing the benefits of the workers themselves.
While we recommend reading the report, we thought it would be helpful to summarize some of these tactics so you will be properly informed and properly prepared in the event of an on-the-job injury.
Expect your claim to be contested. Every state has an administration that adjudicates workers’ compensation claims. This means that every workers’ compensation claim has the potential to turn into a hearing. As a matter of course, insurance companies use this opportunity to deny claims and haggle over treatment costs. Walking into this process without legal counsel is almost a guarantee that you will not receive the benefits that you deserve.
Take a thorough and honest inventory of what the injury has cost you. Insurance companies use a specific schedule when determining what an injury is worth. According the report by the Center for Justice and Democracy, most workers’ compensation groups use a manual published by the American Medical Association to standardize their payment requirements. They do this even though the manual itself specifically advises against doing so:
“Impairment percentages derived from the Guides criteria should not be used as direct estimates of disability…The complexity of work activities requires individual analyses.”
Using this manual as a standard for determining payment allows the insurer to not acknowledge the sort of work that was being done by each individual injured worker. This means that they see no distinction between a bank manager losing a finger and a professional piano teacher suffering from the same injury. In real life, the distinction is enormous. The bank manager could eventually return to work, but the piano teacher would be completely unable to do so. But according to insurance company calculations, a finger is worth a certain amount, and that’s all its worth. An arm is worth a certain amount, and that’s all its worth. You should expect to have to fight to make them see how your injury has affected your life.
Be prepared to justify your entire medical history. Did you play football or any other sport in high school? Did you break a leg or sprain an ankle? Do you have diabetes? Have you ever had problems with drugs or alcohol? Over the course of your life, have you ever been hospitalized? If so, be prepared to explain how these past medical problems were entirely unrelated to your injury.
Workers’ Compensation was initially intended to be “no-fault.” This means that it was intended to provide benefits to injured workers in a completely impartial manner. Over the years, insurance carriers have steadily chipped away at this, forcing the burden of proof onto the injured worker. Some states require proof that the job was at least 50% responsible for the injury. This means that the old football injury that you suffered from 20 years ago might take on a new level of importance in your life.
This also puts you in the unfortunate position of having to litigate and fight for your benefits through hearing after hearing, even as your medical bills and mortgage payments continue to pile up.
Be prepared to be treated like a fraud. You might have noticed over the years that there has been a great deal of coverage on insurance issues, and most of it is bad. The most recent public relations onslaught involved the “medical malpractice crisis,” in which doctors all over the country were being forced out of practice due to skyrocketing malpractice insurance costs. The insurance companies blamed the raise in rates on an avalanche of “frivolous lawsuits,” which didn’t actually exist. The “Workers’ Compensation Fraud Epidemic” was a similar public relations campaign that was heavy on quotes from politicians and examples of a few people that got caught cheating the system, but very light on actual facts.
The end result was a storm of legislation that made life even more difficult for legitimately injured workers that it already was. If you have been injured on the job, you can expect your entire history to be examined to see if you have been involved in any other sort of litigation. You can also expect to be placed under surveillance. Insurance companies routinely keep an eye on people that file claims, and do so in the hopes that they can catch them going against doctors orders. This is such a standard procedure for private investigators that there are even textbooks published on the subject.
Nancy L. Cavey has over twenty five years of legal experience in working with cases involving workers’ compensation and Social Security law. She was peer selected as chair of the Workers’ Compensation Section of the Florida Bar and served from August 2004 through 2005. She has the experience and expertise necessary to help you file a successful and complete workers’ compensation claim.
If you have been injured on the job and feel that your workers’ compensation claim was unfairly denied, contact our offices for a free legal consultation.
Answering these broad-based questions isn’t easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-477-3263.