When people are injured on the job, the standard operating procedure is to:
1- Have the injured worker report the accident to their employer
2- The employer must then fill out an accident report
3- The employer then sends the injured worker for medical treatment.
When an employer files a workers’ compensation claim with the insurance company, this does not mean the employees claim is automatically approved. This can be the case, even with a legitimate accident. Insurance companies are always looking to save money, despite the fact that they are in business to pay for employee’s medical, hospital, and lost wages when they are hurt on the job. Employees need to be aware of how insurance companies often wrongfully deny workers’ compensation insurance claims. Remember that they are only looking out for their own best interests, not the employees.
Workers’ compensation insurance companies hire risk managers to find things in a claim that will lead to a denial in workers’ compensation benefits for the employee. This is the sole job of a risk manager employed at a workers’ compensation insurance company. Risk managers know what to look for when they process workers’ compensation claims so they can deny them. This is the case with insurance companies across the world, not just in Denver. Believe it or not, there is one privately-owned insurance company that saved over $300 million over the last seven years by denying workers’ compensation claims. They make it incredibly difficult for hurt workers to get approved for workers’ compensation benefits so their bottom line looks better and their wallets (or those of their investors) get fatter. One workers’ compensation insurance company uses an 11 point system to help deny and reduce workers’ compensation claim payouts.
Risk managers at workers’ compensation insurance companies do the same kinds of investigations as the worker’s employer does, but they take it a few steps further. Workers’ compensation risk managers look at all the data presented to them about the injuries and the accident, and they ask a lot of “Why?” questions that relate to the law and the system. They also set benchmarks and goals for their investigators, attorneys, and adjustors. Every workers’ compensation claim has a price tag that looks at how the claim is going to end up.
Your doctor may claim you are injured, but remember that risk managers take the causation of the injury further, in that they do not always take the doctor’s word for it. Their job is to look for ways to deny the claim. Lower your risk of having your claim denied or reduced by being aware of the several known ways workers’ compensation benefits get wrongfully denied. Examples of some of the situations that have resulted in the denial or reduction of a claim are:
- An employer’s failure to pay their monthly premiums
- A judge made an error in awarding lawyer fees based on their hourly rate
- Narrow scopes of releasing workers’ compensation cases that allow discrimination
- Medicaid’s payment is a write-off that erases the employer’s liability to their employees
Another thing you should be aware of is that risk managers also look at claims to determine if fraud was committed. They are on alert for workers who pretend to be injured with the intention of filing for disability. Insurance companies do thorough investigations on the injured employees, such as making sure the Social Security number checks out right with the SSA. There have been times when workers’ compensation insurance companies find that the Social Security numbers do not match the employee, so they deny the claim even when the employee is rightfully injured. They will also want to hear witness statements that were involved or next to where the employee was injured to see if the employee was intentionally injuring themselves with the intent of getting workers’ compensation benefits.
Were you injured on the job? Do you believe your workers’ compensation claim was wrongfully denied? You need to hire an experienced Denver workers’ compensation attorney. We can help you get the benefits you deserve. Call today or click here to have an experienced attorney help you make your workers’ compensation case.