Some people do not believe me when I tell them that insurance companies in workers’ compensation claims are ruthless, often break the law and no matter how nice they seem, they are not looking out for you. The “Aha” moment is typically when the insurance company does something that affects your benefits.
This was the case of an injured worker who called me after being on work comp benefits for around six months for a torn rotator cuff and other injuries. A month ago he would have told you that all of his medical care had been paid as had all of his time off work.
Since then, this has happened:
- TTD checks have stopped
- The insurance adjuster will not call back the doctor to approve surgery
- The insurance adjuster will not respond to calls or emails
All of this has been done without any new evidence happening on a case. There has not been an independent medical exam (IME). There are no discrepancies in the medical records. The injured worker has been diligent in his physical therapy. He has never filed a work comp case before.
So his question was, how can an insurance company stop paying on a work comp case without reason?
The answer is they can not do this legally, but they can if there is no case filed at the Illinois Workers’ Compensation Commission.
Essentially they are banking on two things.
- They hope you do nothing about it. Some people get so frustrated that they just give up. They do not think they can do anything about a multi billion dollar insurance company. So hurt people will risk their health, ignore their doctor and try to work.
- That if do get an attorney and file a case that they can say they were “investigating” new information or in the process of scheduling an IME. This is all nonsense, but for workers who do not get aggressive attorneys it becomes a case of no harm, no foul. In other words, the worst case scenario for the insurance company is often that they have to pay benefits that they would have paid anyways.
Does this sound nuts? It does and it is, but it is also the reality of how insurance companies work.
First thing to know is that “taking on” a billion dollar insurance company is not a big deal at all. In fact that happens in every filed Illinois workers’ compensation case of which there are over 40,000 every year. It is quite simply what lawyers do.
Second thing to know is that it costs nothing to hire a lawyer. Insurance companies have been known to tell injured workers that work comp attorneys are expensive. This is simply a lie. It is literally nothing up front to get a lawyer for a work injury.
Third is that if they say they did not pay you for a while because they wanted to schedule an IME or they lie about an investigation, there is something an aggressive attorney can do. We can file for penalties and fees which could result in you getting 150% of what you are owed for TTD and they would have to pay your lawyer a fee too.
The key is to have an aggressive attorney who will really advocate for you. Otherwise they get away with this nonsense.
The bottom line is that it is true that work comp benefits get cut off or denied for no reason. It sucks. It is dumb. But it is also a very solvable problem and one that we have helped reverse thousands of times.
If you would like a free case review, it would be our pleasure to help you. Please contact us any time at 888-705-1766.