Workers Compensation - How To Spot Insurance Company Lies

Workers’ compensation injury claims are not always as simple as some injured workers may think. Workers’ comp insurance companies can be diligent when investigating and denying injury claims, and many times their counterarguments in denied claims are based on inaccurate or even patently false reasons. Workers’ comp insurance companies are primarily in business to generate a profit, and any claims they can avoid paying results in increased bottom-line numbers for all insurance providers. Saving money for the insurance company is always the goal of the insurance claims adjuster, and advancing false information to justify the denial is included in accepted behavior in the view of the respondent insurance company management officers. Here are a few of the deceptive angles that they will use.

Misrepresenting their liability amount

The first falsehood they tend to use in an obvious valid claim is that the offer is all they are obligated to pay. What they often fail to include is how they arrived at that decision, and it usually involves the amount of wage replacement they are required to provide. They can also deny payment on certain medical bills if they think they can justify to the workers’ compensation judges that some element of the injury is not work-related. Many workers’ comp insurance companies will actually cease regular wage replacement payments after opening a claim in hopes of a reduced lump sum settlement by the injured worker. A seasoned workers’ comp lawyer can identify this type of behavior.

An attorney will not help increase benefits

This is also commonly claimed by many workers’ comp insurance company agents and employers as well. However, that may not necessarily be true. Many workplace accident injuries also include evidence of negligence on the part of the employer, which can then result in a potential personal injury lawsuit in standard state court in North Carolina if it is a total fault situation. North Carolina courts only recognize total fault claims regarding personal injuries, and even though only 1% comparative negligence level can justify denying a claim, negligence claims can still be proven by aggressive North Carolina workers’ compensation lawyers when compelling evidence is available.

Overtime replacement wage does not apply

Another false premise they work hard to convince the claimant to accept is the claim that overtime is not replaceable. Those who work overtime regularly can have that income recovered too, especially when working overtime is a regular requirement of the job. If other comparable workers are getting overtime, then an injured worker who would be on that shift can claim the overtime pay as well. Of course, whatever they get the injured employee to accept is just a reduced payout for them, but an experienced workers’ compensation lawyer can keep them honest.

Raises are not included

Injured workers who are in line for a pay raise may also be reimbursed for the increased rate when the other worker scales go up. Workers’ compensation insurance companies may not be informed of this increase, but they also may not want to make the increased adjustment even though they know it can apply. Many injured workers are off for a significant amount of time before returning to work following a rehabilitation schedule or after surgery and ensuring they receive all compensation coming to them is important for our workers’ compensation lawyers.

Additional false claims as bad faith tactics

False claims from any insurance company are clearly bad faith issues that could possibly result in an additional lawsuit against the provider. There are specific rules regarding how claims are handled, but claims adjusters will still misrepresent their obligation if they think the claimant worker will accept the company’s decision with no legal consultation. Any time the claims agent is requesting excessive documentation or being difficult in any manner, there is a relatively good chance that they have lied somewhere along the line or are looking for an angle to deny the claim.

Our North Carolina worker’s compensation lawyers understand the deceptive tactics of workers’ compensation claims adjusters, and we can often catch them misrepresenting the claim in some manner no matter how small the deception may be. Call our offices for a full claim evaluation and let us investigate the assertions from your workers’ comp insurance provider regarding trustworthiness and honesty. It is never good faith to mislead an injured claimant, and we can often prove and correct the misrepresentation.