If you follow the news, you probably read that last week the CEO of UnitedHealthcare was murdered on the streets of NYC in what appears to be a targeted killing. Before I get into how this relates to Illinois workers’ compensation, let me just get off my chest that it’s gross that this murder is getting so much press attention and effort to be solved just because it was a rich guy.
One of the interesting sub plots to all of this has been the number of people on the internet who have said basically he deserved to die because insurance companies are so scummy or (and this is how I feel) he should not be murdered, but there are a lot of horror stories with health insurance companies so the rage is understandable. Social media has been flooded with stories of people who were told things like their breast cancer surgery wasn’t medically necessary.
There was an article about this rage on CNN that made me think of Illinois work comp cases. The bullet casings had “delay, deny, defend” written on them which is pretty much the strategy many work comp insurance companies take. The article referenced how companies are using AI in place of medical professionals to make a decision. It went on to say that only 43% of people challenge denials.
That last part really hit home. We see absolutely ridiculous denials of Illinois work comp cases. There is one reason why insurance companies do that. If they can get away with not paying out on over 40% of claims that they should, they make a ton of money on top of the crazy amount that they already make.
Think about it. If you would have to pay $100 million on cases and avoid $43 million of that, you are crushing it. Of course you are doing that on the backs of hard working people who just want to get better and back to work.
Another interesting statistic in the article is that 45% of the people who are denied said that they didn’t know they have a right to appeal that decision. It’s actually simpler to appeal a denial in Illinois work comp. All you need to do is call a lawyer and have them start a case. That forces the insurance company to either pay or disclose a legitimate reason for the denial.
You’d be shocked how often someone comes to us or other lawyers after being told their case is denied only for it to be practically instantly paid once a lawyer is on the case. It shouldn’t be that way, but this is all insurance company strategy.
And once you realize this is how these companies operate, it’s a lot easier to understand that even when they seem to be following the law you should be cautious. They might be breaking the law in a way you don’t know and they certainly are trying to find a way to shut your case down. And also understanding that this is just business to them hopefully helps you understand that you need to push back. It pains me any time I get a call from someone who never filed a case because of a denial and then comes to me when the time limit for filing has passed.
The silver lining for injured Illinois workers is you don’t have to hope an insurance company will overturn a denial that makes no sense. The Illinois Workers’ Compensation Commission levels the playing field with independent Arbitrators who can force them to pay if it comes to that point.
