April 1, 2020

Why Would my Employer Deny my Legitimate Injury Claim?

I have written a lot on this blog about how strategies you and your lawyer can use to fight insurance company delays, refusal to authorize needed medical treatment and refusal to start weekly wage benefits.

You may be wondering why your employer – and by extension, their insurance company would fight you on a work injury claim that was witnessed and where even the posted panel doctor agrees that your injury arose from your job?

Isn’t there some sort of “good faith” requirement that insurance companies need to meet? And beyond that, what benefit accrues to the insurance company if their delays result in more needed medical treatment and more off-work status for you?

I think you can find the answer to this puzzling question if you review the annual reports to shareholders issued by any major insurance company. As I write this, for example, I am looking at the Annual Report issued by Travelers Insurance Company in 2016. On page 1 of this report, the CEO writes “[i]n 2016, we continued our long track record of delivering industry-leading returns to our shareholders with another year of strong financial results.” The CEO goes on to say that Traveler’s mission is to:

  • deliver superior returns on equity by leveraging our competitive advantages
  • generate earnings and capital substantially in excess of our growth needs
  • grow book value over time

As you can see, Travelers’ CEO has one major focus – making money for Travelers. That is not a knock on him, Travelers or any other insurance company but you have to understand that as a claimant, you are trying to convince the insurance company to issue payments. Their overriding, number one focus is to generate as much profit as possible. Serving the needs of injured workers is not part of the CEO’s mission.

Insurance companies have accountants and actuaries who spend their time working on ways to increase their bottom line. If paying a legitimate claim quickly, or authorizing needed surgery with a specialist helped their bottom line, they would take these actions.

You can be certain that the insurance company responsible for your claim has analyzed data from tens of thousands of claims over the years, and they have concluded that delay and challenging positively impacts their bottom line.

Insurance companies also spend millions of dollars on lobbyists who discourage legislators from passing laws that punish an insurance company for acting in bad faith – bad faith provisions are weak or non-existent in Georgia and in most other jurisdictions.

And finally, remember that you are not the customer of the insurance company. If you were paying the premiums – like you do when you purchase auto liability insurance – the insurer has to balance profits with keeping its customers happy. In a workers’ compensation setting, the insurance company’s customer is your employer, who also has a financial interest in keeping payouts down.

As your attorney, however, my focus is 100% on you, your health and maximizing your benefits under Georgia’s workers’ compensation law. I know which doctors the insurance companies use to deny or controvert (deny) claims and I know how insurance adjusters use delay tactics to squeeze you financially.

Workers compensation in Georgia is no less contested than divorce law or criminal law. This may seem surprising given that you may consider your supervisor and co-workers as friends, but don’t be fooled. Insurance companies will deny fully legitimate claims in order to save money and to use your shaky financial situation to squeeze you.

So if you are tempted to trust that your employer or their insurance company will “do the right thing,” and pay for your medical care and lost time from work, you would be making a serious mistake, Instead, educate yourself about the process and look into the value of retaining an experienced Georgia workplace injury lawyer to challenge insurance company dictates and delays. If you’d like to know more, please call me at 770-351-0801.

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Jodi Ginsberg

Attorney Jodi Ginsberg represents employees who are injured on the job and who need medical care and missed wage benefits available under Georgia's workers' compensation laws.

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