On its surface, workers compensation is a reasonably straightforward system. If you get hurt on the job, insurance exists to make sure your medical bills get paid. If you can’t work while you’re hurt, that same insurance pays you to stay home and recover.
Sometimes, the system works as its meant to work. This is especially true when injuries are minor or the disability is temporary. It’s not worth your employer’s time to fight these claims in most cases, more is it worth the insurance company’s time. The accommodations you’ll need tend to be cheap and minor in these cases, and everyone is willing to play along as a result.
When injuries are more extensive and expensive, the equation changes.
Let’s assume you’ve done everything right during this process. You reported the injury to your employer, went straight to the correct doctor, filed your claim, and have followed your physician’s instructions to the letter. Why is workers compensation continuing to be such a beast?
Your employer faces rate hikes.
Your employer is worried about their budget just like you are likely to be worried about yours, and every claim can raise premiums.
Here’s a nice example from a construction magazine.
“In this example, the claim-free experience mod is 66 percent, which means the premium for the workers’ compensation policy is $105,600. However, this single claim, where the fracture with direct costs is $50,000, will drive the mod up 15 points. When this claim hits the mod (experience modifications are based on the last four years of experience, excluding the current year), the premium will go up by $24,000 to $129,600. This claim will stay in the company’s experience modification formula for three years. In other words, this $50,000 claim ultimately will end up costing $72,000 in additional insurance premiums. In addition to this, there is another $55,000 in indirect costs, making the total cost of this claim $127,000! If the company has a 10 percent profit margin, it will need to generate an additional $1,270,000 to cover these costs.” –Construction Executive
Obviously not all companies feel that they can generate an extra million to cover your claim, and that added pressure is nothing your employer wants. Fighting with you to lower your claim by whatever margin they can may feel like a matter of survival.
The insurance company stands to lose money.
Insurance companies don’t stay in business by paying out every dime they can pay. They stay in business by collecting as many premium dollars as they can while paying out as many claim dollars as possible.
Thus, it is in their interests to deny and delay your money when the claims are too high, even if you have the tightest case in the world.
Sometimes they will back down when you have a lawyer, just because the costs of litigating the case and fighting the case might then exceed the costs of just paying out the claim. It’s a delicate balance for them, but one that’s ultimately based on logic. You can use that information to your advantage.
When is it time to get help?
If you start to see signs your claim will be denied or delayed you might want to invest in help ASAP. The sooner you get a qualified workers compensation attorney, the better.
Contact Talone Law for a free consultation today.