Tricks Insurance Companies Use to Deny Your Claims

As part of our awareness campaign, we are pointing out some common tricks insurance companies use to deny your DBA case. Watch out for these signs, if you see any of them, it is time to talk to an experienced lawyer.

No. 1: Nurse Case Manager

I’ve had clients say that they didn’t get an attorney until they called me because the Nurse Case Manager said that she was going to take care of everything. Or the Insurance Adjuster said, “hey, once you get back home you’ll be treated like a king…blah blah blah.”

The thing you should be aware of just practically speaking is that every time an insurance company does something, they’re doing something to try to minimize your claim.

If they ask for a recorded statement, why would they need a recorded statement from you? They already know what happened.

Insurance companies try to find something that they can use against you in the future.

It’s the only reason that they would want a Recorded Statement from you. They have witnesses, they have the company who knows what happened to you, what the injury was.

No. 2: Beware of Independent Medical Exam

Number two is why would they send you to an Independent Medical Exam at a doctor of their choosing? Wouldn’t that mean that they’re trying to figure a way not to rely on your treating physician? You have the right to choose any doctor. So do it.

That’s probably the only purpose for sending you to an Independent Medical Examination so they can get away with not having to pay for your medical care.

No. 3: Vocational Assessments!

Third thing, they do a Vocational Assessment. What is a Vocational Assessment?

Someone from the insurance company interviews you about all of your qualifications. He asks about all the things that you could possibly do physically even though you could be partially or pretty much permanently disabled.

They’ll be doing this Vocational Assessment to find jobs for you to help you get back on your feet? No! They’re doing it to find a job you can do so they can cut your benefits off.

What’s an Independent Medical Examiner?

They’re trying to find jobs they think they can qualify you to do. They will send those jobs, qualifications and the physical requirements to their Independent Medical Examiner or Peer Review. He will then sign off and say yeah we can probably prove to a judge that he or she can do these jobs.

Well that obviously will reduce the benefits that they pay and that’s the only reason they do it.

An Independent Medical Examiner is any doctor that the insurance company hires to examine you. They can say that you’re ready to go back to work, that you’re faking symptoms, or you’re making it all up, that your doctor’s care is not necessary. So this is when you need a Defense Base Act Lawyer.

What is a Peer Review?

A Peer Review is worse: It’s the insurance company taking all the paperwork, not even necessarily seeing you or reviewing you in person. It’s an insurance company staffer who is hired to say, “OK, let’s cut the benefits down, he’s fine. Based on what I see here, no, he doesn’t need surgery and let’s get him back to work.”

You will need a lawyer to combat this when this occurs. Watch this useful video.

So what I always suggest is that because it costs nothing to talk to a Defense Base Act lawyer, not one penny. And no one’s going to be calling to sign you up. You have the right to ask any question you want about your case, about your situation.

Maybe you’re just out of the military. You’ve done your tours and you’re just taking your first job as a civilian contractor. The best thing you can do for yourself is to first get on the phone with a Defense Base Act lawyer.

Next, get yourself the form so that you can choose your physician and download the LS-1 Form from the website. It’s the First Choice Doctor Form that you complete before you go overseas. Add it to your checklist and then, keep one with you, and give one to your family. Give a copy to your employer when you’re hurt. Keep it with you and list all the specialists that you may need back home in the States or in your home country.

Do a search for a neurologist, a psychologist, an orthopedic specialist, a PTSD doctor, any doctor you want to treat you should something occur that’s out of your control. We don’t like to think of the worst case scenario, but you can be prepared.

What is a Labor Market Survey?

They don’t do it for your benefit. After the Vocational Assessment there’s what’s called a Labor Market Survey done on you. And that they try to search for and find jobs that pay enough money that it will affect your bottom line as to what your compensation rate should be in the future.

In other words they try to qualify you to do a job so they can cut you off.

A Labor Market Survey is when they find you a job. You may be a translator, but you have PTSD. They’ll scan the labor market for any job, menial, physical or not relevant to you and probably under your level of skill and pay. They assess your physical ability and tell the judge, “he can do this job,” just to minimize or cut your benefits off.

They one time told a client that he could work in horse racing as a handicapper. That’s how hard they work to find you a job. But when you have an attorney to fight for you, you’ll be able to fight it with the truth. You’re not left to hang out and figure out how you’re supposed to take the ridiculous jobs they suggest.

What is a Functional Capacity Evaluation?

They want you to go to a Functional Capacity Evaluation. They’re looking for exaggeration, they’re looking for any type of thing that they can think of to say that you’re not trying your best, doing exercises and doing these different bending and lifting things that you may or may not be able to do.

And they only simply do the Functional Capacity Evaluation to try to get you back into the work force under their terms and not under your or your doctor’s terms. So be aware of the Functional Capacity Evaluation as well.

They Will Do Surveillance on You

Finally a lot of times if the case is really and it looks like long-term care is going to be needed, including possible surgery, it’s not unlike, it’s not, it’s not uncommon for the insurance company to do surveillance on you.

Other Tricks: Questioning Your Statements

And that’s just another one of the tools that they have in their arsenal to try to get you trapped up and explaining during maybe in an initial written statement or oral statement they ask you for maybe in a deposition if you’re not represented. They’re going to try to twist your words and say “you acted like you couldn’t do anything, and we saw you in your yard cutting your grass, picking up your kids…blah blah blah and then they’ll try to say that you’re untrustworthy to the judge.

So those are all the things that the insurance companies do to people regardless of you individually because you’re just simply a number to them and they want to try to minimize the number that they’re going to have to pay you.

Don’t Fight Alone: You Don’t Have To

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