December 13, 2019

Double Standards Alive & Well at Insurance Companies

I am currently representing a client with a significant back injury who is currently treating with a posted panel doctor.   The doctor in this case is well known to me and other claimant’s lawyers as a physician who very rarely keeps a patient on no work status very long and who is reluctant to order diagnostic tests or to refer a patient out to a specialist.

This particular doctor apparently gets all of his business from insurance companies and his medical decisions are a byproduct of his source of fees.

I know about this doctor’s bias and the insurance adjuster surely knows this as well, yet I find myself playing the same game once again.  The panel doctor will release my client to full or light duty work.  The insurance adjuster will issue a notice of termination of benefits.   I will file for a hearing and/or a change in treating physician.   Eventually, the adjustor or defense attorney and I will agree on a legitimate doctor who will most likely find that  my client needs surgery.  Benefits will be restored and my client will get the treatment he needs.

Even though the script has already been written, insurance adjusters keep trying to close out cases involving seriously injured claimants.

I suppose that sometimes they get away with this nonsense – either because the claimant is unrepresented or because the claimant has an inexperienced lawyer.

Having been on the other side, I know how this game is played and it is not going to happen on my watch.   Insurance adjusters are quick to cut off benefits but when a physician calls for more expansive treatment, an MRI, or a referral to a specialist, the process usually grinds to a crawl.

I talk about this a lot with clients and colleagues but it bears repeating – you are going to get walked on if you let the insurance company dictate the pace and progress of events.  Timing is everything in a workers’ compensation case and you have to demand action or nothing  happens.

Last week I was recording some videos for my web site and I got to thinking about the insurance company double standard – here is what I think: