It’s no secret that the way insurance companies make money is by minimizing the amount that they pay out. It’s pretty simply that if they collect 50 million dollars in premiums, but only have 10 million in expenses, they will be making a lot of money.
From the insurance company standpoint, they know that they will have to pay out on some claims. What they actually celebrate is not paying out as much as they should. So you may have a clearly compensable case, but the insurance company could still send you a form letter that says, "After a careful investigation, we have determined that your case is not covered under the Illinois Workers’ Compensation Act." Their goal is for you to go along with that and give up your rights. If they try this trick on 10 people and it works on three of them, they have a winfall.
They also try to limit what they pay you by talking directly to your doctor. That is against the law, but they’ll try anyways and sometimes sneak it in to a form that they get you to sign that gives them permission. That’s underhanded, but the good news is that while you shouldn’t sign anything, if you do, it can be revoked at any time. It’s usually the first thing we do.
Recently I came across a scenario I hadn’t seen before. An Indiana resident was injured while working in Illinois. Her claim is filed for Illinois, but the doctors are all in Indiana. Apparently under Indiana work comp law (which I hear is night and day from what we deal with in IL), insurance companies are allowed to talk to doctors. So her doctor was getting calls from the adjuster and he was answering questions that he should not be answering.
I don’t blame the doctor at all as he had no reason to think this was an Illinois case. But because it is, our laws control and he needs to stop talking to the insurance company.
There’s a built in protection against these tricks in that any statements made by the doctor without your permission are not admissible in court under Illinois law under what is called the Petrillo Doctrine. But we don’t want this to happen anway.
Bottom line, if a nurse case manager, adjuster or anyone else other than your attorney tries to communicate with your physician, you should make it stop. They aren’t doing it for your health, they are doing it to try and save some money.
