Dealing with insurance companies on Illinois workers’ compensation cases often feels like a game of cat and mouse. We only represent honest workers with legitimate claims. Insurance companies will still treat some of these people like scammers and fight cases that shouldn’t be denied. They will also use questionable and sometimes outright gross tactics to deny benefits.
One tactic they try to use deals with injured workers who have a “pre-existing” injury. Of course if you go to a doctor on Monday for back pain and then report a work related back injury that Tuesday, it makes sense they’d fight your case. Those aren’t the tactics that concern me.
The ones that bother me are injured workers in IL who hurt their back two years ago, have been fine since and then had a big aggravation of that prior problem at work today. Under Illinois work comp law, any argument that the prior problem should prevent you from getting benefits is ridiculous.
But the worst one of all is for people who didn’t even know about a prior injury? How is that possible? Let me explain.
Let’s say that you break your leg a month ago at work. It happens when a forklift runs in to you. Pretty straight forward case, right? Should be. But then you go for X-rays or a MRI and it reveals an “old fracture” which seems odd to you because you never broke your leg before. The reality is that maybe something happened to you as a baby or what you thought was a sprain in your later years was really a small bone fracture. You never notice it because it required no treatment and hardly limited you. We see this a lot with former athletes and people who have been in car accidents. You can imagine a teenager playing football gets hit in the leg, has some pain, but plays through it.
Now 20-30 years later you are a regular working person and have this accident. You go to the mail one day and see a denial letter from the insurance company because some doctor says your need for surgery is really related to this old fracture, not getting hit by a forklift the other day.
It sounds absurd but it really happens. People are stunned to be denied for a pre-existing problem they never knew about. And sadly some people fall for this and stop pursuing their work comp case. That’s why these insurance companies do it. It’s simply a gamble they take to try and save money. You end up with out-of-pocket expenses you’d otherwise not have.
The good news is that even in a system where insurance companies tend to get away with a lot, I can’t recall a time in my 24 years of being an attorney with this tactic has worked if they get called out on it. It’s simply not defendable and defies logic. What it really is though is a warning sign to any injured worker that you always need to be cautious and look at insurance company claims with a skeptical eye. They don’t pull this nonsense on every case, but on most claims, they will try something to deny your case even when they shouldn’t if they are following the law.
We are Illinois work comp attorneys who will talk to you for free about your case. Call us any time in confidence at 888-705-1766.
