What do insurance companies look for when investigating a Michigan workers’ compensation claim?
Have you ever wondered why some workers’ compensation claims get disputed? What is the insurance company doing when it is investigating your claim?
Here are 10 red flags that insurance companies look for when deciding about paying benefits. Please remember that every claim is different and it is best to speak with an experienced lawyer about your individual situation.
1. Late notice
Many people do not realize the extent of injury until a few days later. This causes them to believe everything will be fine with some rest. Employers have strict rules about reporting and you better not wait to tell the boss.
2. No accident report
There is no statute of limitations in Michigan workers’ compensation. An individual can pursue benefits anytime provided he or she gave notice and made claim. Completing an accident report gives proof that something really did occur. Do not count on the insurance company accepting your word unless some other proof exists.
3. Other employees tell a different story
Our experience shows that co-workers will not testify because they are afraid of losing their jobs. We see this play out when witnesses suddenly forget seeing an accident occur or make up other stories.
4. Inconsistent medical history
Medical history provided to the doctor at the time of accident is key. These records will be reviewed to see if they match current complaints. Medical records will also be reviewed during the investigation to see about any preexisting conditions.
5. Not following medical advice
Insurance companies can stop benefits if a person refuses to follow medical advice. However, this does not mean a person can be forced to have an invasive surgery. Watch out for situations where the doctor says you have a low chance of success from a procedure.
6. Treatment without improvement
Every claimant is different and some recover faster. Insurance companies are quick to dispute medical treatment if it does not appear that progress is being made. Nurse case managers will pressure doctors to change restrictions and stop treatment.
7. Refusing light duty work
Individuals are required to attempt light duty if it is offered. This is called “reasonable employment” and it should be within doctor restrictions. Some employers abuse the system by providing a demeaning job or forcing a person to perform charity work.
8. No good-faith job search
It is now a requirement to perform a good-faith job search. Insurance companies will find hypothetical jobs a person can perform and evidence must be established that no other employer is hiring. Claimants are expected to turn in job search logs and failing to do so will jeopardize payment of benefits.
9. Active on social media
We have seen insurance adjusters make snap decisions about claims just because of items posted on Facebook, Instagram, and Twitter. We recommend shutting down all social media accounts while a claim is open.
10. Inquiring about settlement
Many people want to settle their claim for a lump sum cash payment and move on with their life. It is tempting to pick up the telephone and start negotiating. This can actually backfire when the case manager thinks a person is not being truthful about their medical or employment situation. We recommend having an experienced lawyer reach out and inquire about resolution.
Michigan Workers Comp Lawyers never charges a fee to evaluate a potential case. Our law firm has represented injured and disabled workers exclusively for more than 35 years. Call (855) 221-2667 for a free consultation today.
How insurance companies use IME doctors to abuse the workers’ comp system
Photo courtesy of Creative Commons, by Steve Snodgrass.