Why Would Work Comp Insurance Deny Your Case?

A lot of my blog posts come from talks with injured workers or attorneys on some interesting cases.  When I hear the same question over and over, it’s also a sign that writing about it would be a good idea.

One common query is, “Why would an insurance company deny my case?”  It’s often asked in response to me telling people that even though their case is accepted now, don’t be surprised if it’s denied at some point.

The reason they will deny you is to save money. That’s what insurance companies do. They’ll do it in an accepted case when they think they can.  By that I mean that if they can get an IME doctor to say you are fine, they will.  If they can act friendly to find out what you are doing this weekend to aid their attempts to put you under surveillance, they will.  If you have a nurse case manager on your case, she’ll try to discourage the doctor from scheduling a MRI, surgery or taking you completely off of work.

They do all of this because for them they want to close your case as quickly as possible and spend as little as possible on it.  It’s math and a business decision for them.  People are literally compensated based on how well they screw you over.  They might not seem like terrible people and they might be nice in their regular life. But their job is to reduce the costs on your case even when it is to your detriment.

So they will constantly be looking for reasons to fight you. Every time you go to the doctor they get a copy of your medical records.  They are always reviewed to see if they give them any leverage.  When I used to work for an insurance defense law firm, we constantly got emails asking us if we thought they had enough reason to cut someone off.

And sometimes they’ll just deny you without reason and hope that you don’t do anything about it.  It must work because I often get calls from people who were hurt years ago and now realize they should have done something about it.

Because a denial can happen at any time, it’s best to be pro-active and prepared for it.  This means having a case officially on file and getting assigned to an Arbitrator.  That way if you are unjustly denied you can get a court hearing much faster.  So whether it’s through us or finding an attorney on your own, the safest thing you can do for your case is free. Hire an experienced, competent Illinois work comp attorney and have them in your corner for when something goes wrong.

Bonus tip.  It’s not fair, but many of the games that insurance companies play don’t happen when a lawyer is on the case because they know we’ll punish them for not following the law.  We’ve also saved many an injured worker by warning them about surveillance tricks, nurse case managers and other tactics used to harm you.