Unfairly attributing the injury to a non-work related factor: The insurance carrier may deny your claim by unfairly trying to blame your injury on causes or factors not related to the workplace.
Medical Provider Network (or “MPN”): If your employer has a Medical Provider Network, you may be forced to receive treatment from a doctor approved by the insurance company. You can avoid this by pre-designating a primary treating physician before your injury.
Depositions, investigation, and close surveillance: Insurance companies use depositions, statements, and observations to scrutinize the medical conditions of injured employees. These tools aim to create evidence which can be utilized to limit or deny medical treatment.
Insurer selected utilization review doctor: A utilization review doctor who is chosen by the insurer must approve most medical tests, treatments, and medications. These utilization review doctors often deny tests or treatment the injured worker needs and the process to fight such denials are complex.
Demand Rushed QME Examinations: Qualified Medical Evaluators (“QME’s”) are state-assigned physicians who examine injured workers to resolve medical disputes, such as whether a person’s injury is work-related. If you are to be examined by a QME, the state will send you a list of three physicians to choose from. The QME will play a very important role in determining the outcome of your case, so it is obviously crucial that you select the best physician from the list. However, most injured workers do not have any idea about how to go about picking their QME, so insurance companies and employers frequently demand a QME examination before the injured worker has hired or even spoken with an attorney. You should always consult with a competent and experienced workers’ compensation attorney before selecting a QME.
For each of the insurance company tactics mentioned here, our firm has methods we can employ to help secure medical treatment and benefits for our clients.
Remember, injured workers have rights, and our firm is committed to helping you assert those rights. Our firm has the tools to help you receive the medical treatment and services you need. When representing you, our aim is to help maximize the medical treatment, benefits, and financial compensation you receive.