Tricks Insurance Companies Use to Deny Your Claim

By | February 6, 2021

What I’d like to do is talk to you very practically about insurance companies under the Defense Base Act. There are only a few of them that kind of monopolize the market. I don’t like insurance companies because I used to be in-house counsel for an insurance company for a period of time. For a long period of time, I was outside counsel for insurance companies so I know exactly how they work especially how they work under this law which is really, really bad. I’ve had clients say that they didn’t an attorney until they called me because the nurse case manager said that she was going to take care of everything. Or the 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. What I mean by that is if they ask for a recorded statement, why would they need a recorded statement from you? They already know what happened. They know that you were injured at work. They want to 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 knows what happened to you, what the injury was. They don’t, they don’t need that. 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 who’s telling you that you need these things? That’s probably only that’s the only purpose for sending you to an independent medical examination. Is to try to get away with not having to pay for your medical care. Third thing, they do a vocational assessment.What is a vocational assessment? Well someone interviews you about all of your qualifications 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 try to find jobs for you to help you get back on your feet? No! They’re trying to find jobs they think they can qualify you to do to send those jobs and the qualifications and the physical requirements to send to their Independent Medical Examiner or Peer Review person to 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. They don’t do it for your benefit. After the Vocational Assessment, there’s what’s done a Labor Market Survey is 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. Another two things the insurance companies do to try to minimize your claim or get away with not paying you are: Number One they want you to go to a FunctionalCapacity 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 todo. And they only simply do the Functional CapacityEvaluation to try to get you back into the workforce under their terms and not under your or your doctor’s terms. So be aware of the Functional Capacity Evaluation as well. Finally, a lot of times if the case is real 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. 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 may be 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. So that’s all I do for a living I fight for the true value of the claims for people that I represent but it’s one definitely worth pursuing. Like I said sometimes they act like they’re trying to help you out and doing all these things. There’s absolutely no reason why they would do any of these things other than to try to minimize what they have to pay you. And so anytime you start to feel a little uncomfortable about these things that they’re trying to do that’s the time you’ve got to call an attorney. If you don’t call me, please call somebody else that specializes in the Defense Base Act because it’s complicated, and they have giant resources and an entire industry on their side playing these games to try and reduce or completely cut off your benefits. So again I’m Brian Wiklendt with Garfinkel Schwartz. I’ll come to you call me anytime 24 hours a day. Check out my website, our website is Brian Wiklendt again signing out thanks for listening in Maitland Florida.

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