Unfair Tactics Insurance Companies Use
The law states that workers’ comp insurers have to follow specific procedures when they want to lawfully terminate or reduce Massachusetts workers’ benefits. These procedures vary depending on how long injured employees have been getting benefits.
In most workers’ compensation cases, insurance companies play by the rules, but there are unfair tactics some often use to deny workers the benefits they deserve.
If you are being unjustly denied workers’ comp benefits after suffering a serious injury or illness at work, you need proper legal representation.
Common Unfair Insurance Company Tactics
When injured workers file a workers’ comp claim, they rightfully expect their employer’s insurer to act in good faith. However, it is surprisingly common for these insurance companies to employ unfair tactics when dealing with and investigating claims.
Such tactics are unethical and sometimes even illegal. Some of the most commonly used by insurers include:
- Making low offers
- Unjustifiable delays
- Conducting incomplete investigations
- Misrepresentation
- Form 105
Low Offers
Insurance companies often take a chance with unfair tactics, especially when they realize injured workers do not have legal representation.
Perhaps the most commonly used unfair tactic in these situations is to outright deny a workers’ comp claim even though it is valid. Yet another is to approach an injured employee with a low settlement offer before he or she has had a chance to consult an attorney. Insurers do this to pay a sum that is much lower than what the claim is really worth, saving them money.
Unfortunately, a lot of workers assume the insurer actually has their best interest in mind when it is the other way around. If you are approached by your employer’s insurance company with an offer before you have talked to a workers’ comp lawyer, you should not accept until you get legal advice.
Unjustifiable Delays
Another unfair tactic insurance companies turn to is to make unjustifiable delays during the claims process or when they must issue payments for a valid claim. When the claim is still in process and insurers realize they are bound to lose, they use this tactic to get injured workers to settle for less than they should.
As injured workers’ medical bills and other financial responsibilities pile up, they may well get so frustrated with these unfair delays that they end up accepting much less than they are entitled to. Do not let this happen to you. It is imperative that you turn to a qualified workers’ comp attorney who will employ legal means to keep insurers from dragging their feet.
Incomplete Investigations
Often, it is in an insurance company’s best interest to ignore certain facts in a workers’ comp case. For example, if a worker is injured outside of his or her immediate work area, it is usually held that workers’ comp benefits do not apply. However, there are clear exceptions such as when an employee has been ordered out of that area on an errand directly related to work. This is a fact that an incomplete investigation may choose to ignore altogether.
Insurance companies have a duty of good faith to conduct complete investigations and take all facts of a case into account. When they fail this duty they are acting in an unethical and possibly illegal way just to save money.
Misrepresentation
Insurance matters tend to be complex. So much so that injured workers are often confused by forms they are presented with by insurers. This allows insurance companies to use ambiguous language and legal terms to misrepresent facts.
Depending on the circumstances this can be considered illegal and lead to insurers getting into serious trouble. Unfortunately, when injured workers do not retain legal representation, they are often unaware they are being taken advantage of.
Form 105
One of the most popular unfair tactics among workers’ comp insurers is Form 105. Injured workers who have been receiving benefits often get a form from insurers known as “Form 105, Agreement to Extend the 180 Day Payment Without Prejudice Period.”
Because of this form’s name, it appears that the insurer is trying to help out the injured employee by extending benefits, but that is far from the case.
Workers’ comp insurers employ this form with injured workers who do not have an attorney on their side to get them to sign without realizing the negative implications of doing so. Employees usually get this form 3 to 5 months after a work-related injury.
You have to be aware that signing this form means you are surrendering legal rights and this could open the door to the insurer terminating your benefits. Rectifying this by legal means could take several months without benefits.
If you have already gotten Form 105, do not sign it. Get in touch with a workers’ comp attorney for the right legal advice in this situation.
Do I Need a Workers’ Comp Lawyer?
After a work-related injury, you might be wondering whether hiring a workers’ comp lawyer is something you should do. The answer is that it depends on the particular circumstances of your case.
Not every injured employee has to hire an attorney. Getting workers’ comp benefits is supposed to be relatively easy after a work-related injury or illness. If your injuries are minor, the process for you should be straightforward provided they did happen at work and you are an employee as opposed to a contractor.
Unfortunately, things are not always that simple. If your injury is significant and the insurer is using unfair tactics, you definitely need a workers’ comp attorney to obtain the benefits that are rightfully yours.
Other reasons to hire a lawyer who specializes in workers’ compensation cases include:
- Your claim has been denied
- Your Permanent Disability rating is in question
- A preexisting condition
Reach Out Today
If you are dealing with unfair tactics from your employer’s insurer after an injury or illness due to your job, you need legal help. Having a workers’ comp lawyer on your side can ensure that your claim is handled fairly.
Reach out to us at the Law Office of Robert E Frawley at (617) 523-2929!
