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I’ve written a lot about the fact insurance companies don’t view you as a person, but instead as a claim number. Their job is to make sure that your claim costs as little as possible.  So they’ll tell you a case is denied when it shouldn’t be just to see what happens.  Maybe you go away and they save a lot of money.  They’ll be late on your TTD checks with the hopes that you’ll ignore your doctor and return to work.  They’ll refuse to authorize an MRI or a cortisone injection until you see their IME doctor in three months while wishing that you’ll just use your personal insurance instead.

These games usually stop when you get a lawyer, but not always.  If they can discourage just one out of ten people it’s a big money saver for them.

It’s not just at the beginning of the case that this happens, it often happens during the case.  A recent Appellate Court decision shows how true this is.

What happened is an over the road truck driver hurt his spine and ended up with a back surgery.  There was no dispute that he had a work related injury and benefits were paid right away.

While off work due to his injury he had a violent sneezing episode that made his back feel worse. It had already been proven that he had a disc herniation and a second surgery was already recommended before this happened because the first one didn’t solve the problem.

Because he was honest and told his surgeon about the sneezing episode, the insurance company tried to jump on that and say that it was a new accident that is not work related and broke the “chain of causation” between the back condition and work accident. In plain English they were basically saying because you sneezed it made your back way worse so we shouldn’t have to pay you.

The Courts in Illinois fortunately got it right and made the insurance company pay. It helped that pre and post sneezing MRI’s showed the same thing and that there was no new herniation.  In general though this shows how ridiculous an insurance company can and will be.  Do they expect that you won’t sneeze or cough at any point after you get hurt?

To them it’s a money saving game and while they lost this one, they win plenty of others by being ruthless and heartless.  It’s shameful, but you need to know what you are up against, especially when you have a serious injury.  Sometimes they act nice, but I assure you that they are trying to cut off your benefits if they can find a reason, even if it’s for an absurd reason.