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Workers’ compensation insurance companies make money by reducing the amount they have to pay out in a case.  That can mean not offering a settlement or not paying for medical care that you clearly need.  Their hope in that situation is to frustrate you and get you to use your personal insurance.  That can be a bad idea because your personal insurance might come after you for reimbursement or could deny payment for future medical care for other problems.

This happens all of the time and often in a sneaky way where they say your case isn’t denied, but they need more information or are still investigating the case.  Take this description from an injured worker who contacted me a while back:

My worker’s comp company is refusing to pay for a surgery they are responsible for. Their claim is not that they are not responsible for paying for it, but that the hospital did not send them enough information. The hospital is insistent that they sent all the information possible but the company is still stonewalling me.

This is a typical insurance company bogus game.  They have all of the information they need.  Work comp isn’t rocket science.  There’s no dispute that her injury occurred at work. Her doctor says she needs surgery from it.  That should be it.

But insurance companies have figured out that if they pull this nonsense 100 times, a certain percent will not push the issue. That means they save money and it’s how they make billions a year. It’s just business to them even if your health is at risk.

What’s crazier about this case is that it’s the second shoulder surgery due to the work accident from 2020.  They paid for the first one and certainly aren’t in need of any more information.  But because this nice woman who just wants to get healthy and work hasn’t pushed back, they are messing with her.

It’s an easy problem for a lawyer to solve, but one that shouldn’t happen at all. When they say they are investigating, researching, need more information, gathering the facts, etc., those are code words for “we are trying to screw you, let’s see if you catch on.”  Your only recourse in that situation is to get a lawyer because otherwise you will wait and wait and wait.  The sooner you realize that to the insurance company it’s a game, the better your chance of a successful outcome.