Tactics Insurers Use To Devalue or Deny Workers’ Comp Claims

Many workers head into work each day, not giving the thought that they may suffer an injury on the job a second thought. The reason many employees do is because they’re well aware that Maryland law requires most employers to purchase and maintain active workers’ compensation insurance to pay for their job-related injuries or illnesses.

While workers’ comp can provide workers with a way to receive compensated medical care, just like any insurance coverage, there’s no guarantee that an insurer will pay on the claim submitted to them, or at the very least, pay the full amount of the bill. Below, we’ll highlight some of the many tactics insurers use to devalue or deny workers’ comp claims so that you can be on the lookout for them if you find yourself in the unfortunate situation where you need to seek compensated care here in Baltimore.

Common Reasons for Denials of Workers’ Comp Claims

Workers’ compensation insurers often deny workers’ claims because:

• The worker filing the claim is not considered a “covered employee”: Maryland workers’ compensation laws require virtually every employer in our state to carry workers’ compensation coverage provided they have at least one part-time or full-time employee. One of the only exceptions to this rule is if the employer is an agricultural company with annual labor costs lower than $15,000, or less than three workers. Another type of worker that wouldn’t typically be covered by an employer’s workers’ comp policy is a self-employed person or independent contractor.
• An employer disputes that the injury or illness is job-related: Although Maryland workers’ comp is a no-fault type of insurance, it still must be clear that the onset of your illness or injury occurred as a result of your employment. Some situations that may result in injuries or illnesses that aren’t considered coverable are if they occur while you’re driving to or back from work, they result from horseplay or an intentional act (such as alcohol intoxication), or involve policy violations or result from your engagement in illegal activities. You may find yourself needing to somehow prove that your injury incident occurred while you were on the job if your employer disputes that it did to receive these much-needed benefits.
• They delay in notifying their employer of their injury: Maryland requires employees to let their employers know they suffered a job-related injury or are experiencing an occupational illness within ten days of its onset. However, it’s always best if workers notify their employers of such immediately upon becoming hurt or ill, per the Maryland Workers’ Compensation Commission (WCC).
• They submit their claim beyond the required timeline: Maryland laws give covered employees who suffered a non-fatal accidental injury on the job 60 days to file a workers’ comp claim. That time frame extends out to 18 months when the accidental injury resulted in the employee’s death.
• You didn’t seek prompt medical attention for your injuries or illness: Maryland is one of a few states that allows you to select your own doctor to see if you’re hurt or fall ill on the job. You can think of seeing a doctor, much like filing a police report after an auto accident. Seeing a physician for what ails you provides you with documentation of what you’re going through. Continuing to see a doctor shows progression, such as improvement or worsening of your condition.

Situations in Which an Insurer May Try To Devalue Your Workers’ Comp Claim

Workers’ compensation insurance companies operate similarly to adjusters handling any other insurance claim. Their objective is to deny claims and keep settlements as low as possible to ensure the continued profitability of their operation. While outright denying a claim may not always be a viable option for insurers, definitely devaluing it might be. Some tactics insurers use to do this include:

• Requesting recorded statements of how injuries occurred: Insurers often ask to record what you said happened leading up to your injury in hopes of catching you saying something they can use against you to pay less when you request to settle your case.
• Extending you an offer of a light-duty job: Your employer and their workers’ compensation insurer may work in cahoots with one another. The company you work for may offer what they maintain is a light-duty job if they find out that your doctor has released you to perform such type of work. An employer may ask you to perform increasingly labor-intensive (heavy-duty) work. Your employer could report this to the workers’ comp carrier as you “faking” your injury, resulting in you losing benefits. Alternatively, an employer may give you the false impression that you’re no longer eligible for coverage since you returned to work when you really are, causing you to lose the significant compensation you’re entitled to.
• Taking a long time to process claims: Insurance companies usually are given 21 days to dispute an employee’s claim or otherwise remit payment to the injured or ill worker. Insurers are notorious for pushing back on claims by requesting additional documentation, which may cause a much longer delay. Their hope is that by continuing to drag out processing times, you might give up your fight for fair compensation and abandon your claim altogether or settle for much less than they’d otherwise expect to pay out.

How a Workers’ Compensation Lawyer Can Help if You’ve Been Hurt at Work in Baltimore

Becoming involved in an accident at work that leaves you injured or experiencing the onset of an occupational illness can be unnerving. Finding yourself in a position where you have to spend your days treating or recovering from a medical condition and cannot work to make money to cover everyday essentials can be hard to cope with.

While your Baltimore employer’s workers’ compensation coverage can provide the means for you to receive much-needed medical care and recover lost wages, insurers often fight aggressively to keep any potentially recoverable compensation in their grasp. This is where aligning with a Maryland workers’ compensation attorney can be beneficial. They’ll know how to guide you in handling your case to ensure the best possible outcome.

Our Belsky & Horowitz, LLC attorneys are standing by to help you navigate your workers’ comp case. Call or email us to schedule a free initial consultation to discuss where things stand and how you should proceed in your legal matter.