Workers’ Compensation: It’s A Dirty Business

Insurance Investigators

If you have a pending claim for workers’ compensation benefits in New York and notice a suspicious vehicle in your neighborhood, you’re not alone. After all, the insurance carrier is concerned about one thing, their bottom line. The use of insurance investigators has become more and more common in New York Workers’ Compensation cases to unveil evidence that may allow them to reduce their liability costs. The problem is the vast majority of Workers’ Compensation claimants are honest, hard-working people who do not deserve to be treated like criminals.

The media, funded by big insurance dollars, continues to perpetuate the myth that Workers’ Compensation claimants are lazy, dishonest people who simply want to milk the system. By and large, this could not be further from the truth.

My advice to clients who repeatedly notice strange vehicles in their neighborhood is to contact the local police department. While the police may not be able to make an arrest, they can certainly investigate and determine who owns the vehicle and what they are doing in your neighborhood. At the very least, this will alert the insurance company that their investigator has not done a very good job and has been exposed.

By no means do I believe that Workers’ Compensation fraud does not exist. It does. I have seen instances of claimants working on roofs and lifting heavy objects while at the same time collecting full disability payments from the insurance carrier. These people should be prosecuted and belong in jail. Unfortunately, the widespread unethical insurance practices result in an invasion of claimant’s privacy. In my opinion, most surveillance is unnecessary and amounts to harassment.

Nurse Case Managers

Surveillance is not the only tactic that insurance carriers use to try to protect their bottom line. In New York, nurse case managers are utilized by most Workers’ Compensation insurance companies. They will explain that it is their job to expedite medical care and to keep their claim running smoothly. The unknowing claimant simply believes this is how the system works. That person is unaware that the nurse case manager is hired, and paid a significant salary, not to help the worker but to cut costs. Nurse case managers often follow injured workers to their doctor appointments as if a chaperone is needed to deal with the attending physician.

In most instances, the nurse case manager’s job is to reduce the amount of your weekly check, keep your medical treatment costs to a minimum, and get you back to work as soon as possible whether you are physically ready to return or not. I have seen cases where the nurse case manager actually asks the doctor to change his opinion and reduce the patient’s disability rating. All the while, the injured worker believes that the case manager is there to help him or her.

In my practice, as soon as a client informs me that a nurse case manager has contacted them, I demand that all further contact cease immediately.

It’s hard enough to try to make ends meet when you are disabled as a result of an injury. Investigators and nurse case managers only make matters worse. Unless you have been disabled from work for a lengthy period of time, you probably don’t realize how difficult it can be. Bill collectors don’t care that you have been injured and are not receiving your full pay. It is not uncommon for an injured worker’s credit to be damaged or ruined all together.

Hearing co-workers or friends question your credibility is also damaging to the psyche and being unable to provide for your family can cause feelings of inferiority and anger. To say that a work injury puts extra stress on a marital relationship and impacts the entire family unit is an understatement. Unfortunately, the insurance carrier continues to look at their bottom line and there is no right or wrong when it comes to defending Workers’ Compensation claims. If one accepts the ridiculous propaganda that is written and broadcast, he will believe that the insurance carrier is the victim. The Workers’ Compensation system is truly a dirty business.

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Loresjoberg

Chiropractic