Most people are under the impression that the insurance company is on their side, whether they have been involved in a car accident, require healthcare, or have been injured at work. Unfortunately, the insurance industry is one of the most unscrupulous industries out there. The insurer will happily take your monthly insurance premium payment, but heaven forbid you have to actually file a claim.
It is more common than you might think for insurance adjusters to do everything in their power to minimize the amount they will be required to settle for, and workers compensation claims are no different, especially since the insurance company isn’t yours, but your employer’s.
Continue reading to learn more about the standard approval requirements for work comp benefits across the U.S., and how insurance companies manage to take advantage of injured workers who seek these benefits.
Criteria for Claim Approval
Every state has their own laws when it comes to workers compensation. Some states don’t even require companies to carry workers comp coverage, although most do. Generally speaking, the only requirement an employee needs to meet in order to qualify for workers compensation benefits is that their injury or illness needs to have been caused by their work environment.
A workers comp lawyer in Long Island brings up a good point, however, in saying that many factors can render a person ineligible for benefits even if their condition was caused by their work responsibilities, including missing certain deadlines or working off the clock, for example.
When the ability to be eligible for workers comp primarily falls on how and where the accident happened, it is alarming just how frequently insurers will find every reason in the book to deny deserving claimants the benefits they need to simply survive until they recover and are able to go back to work.
Money-Hungry Insurers Issuing Denials
Part of an insurance adjuster’s job is to go through the claims they receive and find any discrepancies, valid or not. For instance, if you previously had high blood pressure and suffered a heart attack after doing manual labor at work, the insurer might accuse you of having a pre-existing condition, and argue that this condition is what caused you to suffer a heart attack, not the hard labor you were doing that day.
Another common tactic is for the insurer to request that claimants submit to an independent medical exam that is, of course, conducted by a physician hired by the insurance company. As you can imagine, the results of these exams will more often than not come down in favor of the insurer, as they paid the physician to examine the injured worker.
In any case, the insurance industry as a whole is ridiculous. It’s high-time that this industry be regulated so that these large corporations can no longer prey and take advantage of people who are just trying to get through the day.