There was a great tweet thread the other day about a Colorado work comp case that has a lot of similarities as to how insurance companies deny Illinois workers’ compensation cases in bad faith.
The gist of it is that an electrician got hurt work when he slipped on some ice. In falling he tore his rotator cuff. He went through one year of physical therapy, which, by the way, is a really long time. After a MRI and the failed therapy, his orthopedic doctor recommended surgery. He needed approval from the work comp insurance and they said no.
They had either sent the worker for an IME or sent the medical records to a different orthopedic doctor. That physician said that surgery wasn’t necessary and more PT and steroid injections was the solution. The treating doctor thought this was odd so he investigated.
It turns out that the insurance company doctor was licensed, but banned from doing surgeries since 2017 by the medical board due to mistakes he made in multiple surgeries. Among other allegations was that he put a hip in backwards when it was replaced.
So basically the income stream of this doctor is cut off and to make up for it, he has to do these types of exams. While I don’t know him personally, it sure sounds like he’s a hired gun who will say what the insurance company needs to hear. Depending on how many of these reports he’s doing a year, he could be making in the seven figures off that alone. There are plenty of doctors in Illinois who do that.
And this is how insurance companies screw over workers and decide not to pay benefits or for medical procedures. They find doctors who will for the most part give them the opinion they are looking for. Often this happens after an exam that lasts less than five minutes. And they side with this opinion over your treating doctor who has provided care for your case over a long period of time.
It’s truly insane. And while we can usually win this type of case, especially when the insurance company doctor obviously isn’t credible, it sucks that treatment gets delayed and the worker has to suffer.
These are the types of things insurance companies do even when it seems like they are doing everything right or being nice. They are always looking to cut you off if they can.
And while sometimes they just cut you off without reason, in most cases this is how it’s done. And if it feels like the game is rigged, it’s because it often is. It’s why you need an attorney who knows what they are doing to push back and fight for you.