Has Your Claim Been Denied? Claim Denials

Has Your Claim Been Denied?  Claim Denials or “How to Reduce Your Own Workload as a Claims Adjuster by Denying Claims”

In the last few years the landscape in California workers compensation has changed.  Instead of the intended benefits delivery system, insurance carriers are in the “delay, deny, defend” mode.  I previously worked as a senior defense attorney for major corporations, litigating the claims from the insurance companies’ side.  Legal changes have shifted the landscape so that it heavily favors the carrier now, not the employee.

Work injury claim denials should be rare.  There are exceptions of course, intoxication, horseplay, the employee was fired before he reported an injury, and a few others. From my experience as both an applicant and defense attorney I estimate that 65% of all denials are done in bad faith.  Adjusters can control their own workload, and if they deny a claim, it is effectively closed for their workload purposes. They deny treatment, and injured workers end up suffering, unaware of their options.  Most adjusters do not receive the legal support and training to adjust claims.  Adjusters also have very high caseloads, and will often handle 300 claims at a time.

By stating that denials are in bad faith, I mean that even though the facts are such that everyone should agree there was or is an injury, and the employer agrees, yet the insurance carrier still denies the claim.

 

Wright and Falls will meet with you for a free 45 minute consultation regarding your denied claim and provide you with an honest assessment on your options and the likelihood of overturning the denial.