One thing I say repeatedly to people with Illinois workers’ compensation claims is that the insurance company is always looking for a reason to deny your case. This is true even when your case is accepted and they are paying benefits. They might even be nice to you, but behind the scenes they are trying to figure out a way to cut you off. Some of their tactics include:
– Taking recorded statements of you. The hope is to trip you up in to saying something that will provide a defense.
– Assigning a nurse case manager to your case. They often will illegally talk to your doctor to try and influence your medical treatment or job restrictions.
– Surveillance. The longer you are out, the more likely it is that they’ll pay a company to follow you and video tape you. If you have a lifting restriction, but are feeling good and try to do something you shouldn’t, they’ll say you are faking and end your benefits on the spot.
– Independent medical examinations. There are plenty of hired gun doctors who will say whatever the insurance company wants them to say as cover for your benefits getting terminated. It’s no coincidence that we see the same doctors used over and over on these cases. Some of them make high six figures on these examinations and depositions.
Other times they deny with no reason. You’ll just get a letter saying that your after an investigation they’ve determined that your case is not compensable. Of course there is no real investigation in most of those instances, but that doesn’t stop insurance companies.
So the question is what do you do if your case is denied?
1. Don’t panic. This happens all of the time because while this is your life, it’s business to the insurance company.
2. Consult with an experienced attorney. It’s free and it allows you to educate yourself as to whether or not you do have a good case and if so what an attorney can do for you. In most cases this does mean hiring a lawyer. If you do there are motions that we can file to work toward getting your benefits reinstated.
3. Explore other options for medical care. If you need a surgery or physical therapy, your body can’t wait on the work comp system. If you have a denial letter from work comp, you should be able to get medical care through your group health insurance provider. Don’t do this without talking to your attorney first, but also don’t feel like you have to wait a while to get the treatment you need. A good lawyer will protect you in this situation.
4. Talk to your doctor. This should be done in conjunction with your lawyer, but to win benefits, you need a statement from your doctor that about what treatment you need and that your condition is work related.
5. Don’t trust the insurance company. This should probably be first on the list. I can’t even count the number of times someone has reached out to me after the insurance company denied benefits where they did so in blatant violation of the law. They aren’t looking out for you.
It’s really not much more than that. These cases aren’t rocket science. They just require someone who knows what they are doing. And they require you to look out for you and not let the insurance company push you around.
If you’d like to speak with an experienced work comp attorney for free, you can call us any time at 888-705-1766.