When a claim is reported to the insurance company, the adjuster predicts how much that claim is going to cost the company and reserves that amount in the system. When the claim actually comes in, if it falls within the amount the adjuster predicted, everything is fine, and the claim is generally approved.
If the claim ends up being an amount greater than the adjuster predicted, the problem starts. Adjusters — and their management — don't want to pay more than what was reserved in the system and begin the process of finding ways to deny the claim. The company will send you to one of its own doctors hoping that it can get a medical opinion to back a claim denial. The insurance companies will search for tiny technicalities in your case or any reason they can find to turn down your claim, even though that is the money you need to pay medical expenses and bills.
Most insurance companies are for-profit companies. They have profits to report, shareholders and bonuses to pay. In short, they are in business to make money. Making higher profits is as simple as taking as much as possible in premiums and paying as little in claims as possible.
The insurance companies know that many hardworking individuals probably do not know all the details of the workers' compensation act and are unaware of just what their rights are. While questioning you, the adjuster can structure questions in such a way that the claim can be denied later.
Lake County Injured Workers' Rights Lawyer
The system may seem stacked against the injured worker, but you have rights.
Following a work-related injury, you have the right to see your own doctor. The insurance company may tell you otherwise. Many times your own doctor's opinion carries more weight in court than the doctor hired by the insurance company.
If the insurance company is going to deny your claim, preventing you from getting medical treatment, it must have a valid reason. If that reason is not put in writing, the company can be penalized. We cross-examine doctors and cover every medical detail to punch holes in the opinion of the insurance company's doctor.
Our attorneys fight for the rights of Illinois workers. Contact Hannigan & Botha, Ltd., today at 847-949-1070 for a free consultation and to learn more of what the insurance companies don't want you to know.
