5 Dirty Tactics Insurance Companies Use To Block Workers Comp Claims

Imagine your bad boss (or co-worker) has abused you for the last time and you’re ready to crack. You’ve had enough and this time you’re going to do something about it. You’re feeling angry, disrespected, you can’t sleep properly, you snap at the merest thing (especially at loved ones) and your mental health is going downhill fast.

Before you rush to your GP to start a worker’s compensation claim, pause for a moment and read this article fully. To properly consider your options, there are some things you need to know about the dodgy tactics insurance companies use when it comes to worker’s compensation claims for psychological injuries.

(Oh and by the way, see the links at the end of this article if you want to find out more about insurance company dirty tactics - and discover that I’m not just making this up! What follows is an account of what I’ve experienced professionally with regards to my clients’ worker’s comp claims - and you’ll see it’s congruent with what’s in the articles listed below.)

If you’re at crisis point, it’s advisable to slow down, pause and reflect. Before getting that certificate from your GP, at least take a couple of weeks’ stress leave and think about if you really want to go down that path. At this point, stalling is your best strategy. Find out what your other options are as well.

Those who have been through the system will often tell you although being bullied at work was horrific, the day they started down the worker’s compensation path was when their nightmare truly began.

When the insurance company receives your claim, they kick into “damage control” mode. That means they are highly motivated to find any means by which to avoid paying you compensation. Why? Because claims related to psychological injury are expensive; workplace bullying alone costs Australia $6 billion to $36 billion per year.

Here are the 5 dirty tactics the insurance company will use against you:

1) “Doctor Shopping:”

Your insurance company will send you to a so-called “Independent Medical Expert” (IME). In the case of a psychological injury, you’ll see a psychiatrist for an assessment of your mental health to determine if your claim has substance. Insurance companies are motivated to cherry-pick the IMEs whose professional opinions they prefer – those who will “sava da money.

What this means in practice is that when you get sent to your insurance company psychiatrist of choice, s/he will grill you about your past in an attempt to find anything that provides a better explanation for your current distress than workplace bullying. Thus, if you’ve had post-natal depression 20 years ago, or a medical trauma in your childhood, or a bad breakup with a spouse, they’ll find a way to pin your symptoms on other historical events.

2) Insurance Companies Are Adversarial:

The onus is on you to prove your case, with good-enough, rational evidence. You need a clear story, well-articulated with solid evidence to back it up. This is very difficult to achieve when you’re so stressed you can’t think straight!

The insurance company has a (not-so) secret hope that if they make the process as hard as possible, you’ll give up without seeing the claim through. Then KABOOM! The insurance agent gets a great bonus because he “sava da money” for the boss (more about that later).

3) Manipulation Of Financial Bonus Schemes:

Insurance companies have financial incentives to reward their agents for managing claims effectively. However as with all incentive schemes, they can be abused. Certain agents are not above manipulating the system or stalling the resolution of cases to maximise bonuses.

One common scenario is that agents might be rewarded for facilitating the termination of claims before they reached milestones of 13, 52 and 134 weeks. Alternatively, they might be penalised if they don’t meet these targets.

4) Stalling:

Insurance companies do as much as possible to delay paying your medical expenses / settlement. Even though it’s 2017, most of them tell you: “your cheque is in the mail.” It takes over a week for the cheque to arrive (unless it gets lost in the post - which happens regularly), then several more days to clear at the bank. I wonder, does it mean they get to make money on the short-term money market? It’s another infuriating aspect of dealing with insurance companies.

The propensity to send cheques in the mail also means that many health professionals refuse to invoice a third party, because insurance companies are so difficult to deal with.

5) Industry-Specific Rejection Of Claims:

In October 2015, 44.5 % of police mental health claims were rejected, compared to just 4.7 % of claims involving physical injuries. Police work often involves dealing with a high degree of trauma - not only on the job (shootings, car accidents, domestic violence, etc..) but also because a lot of workplace bullying goes on in the police force.

Paramedics are another industry with a high number of mental health claims and subsequent rejections. It’s all financially driven. In cases like these, the appointed IMEs will often aggressively argue that Post Traumatic Stress Disorder (PTSD) was caused by something other than what happened on the job.

It can be so debilitating to fight against the insurance company after all you’ve already been through, that some claimants even succumb to the pressure by taking their own lives. And the insurance company / employer will never take responsibility or apologise!

To find out more about how to deal with these 5 low-down dirty tactics insurance companies use to block worker’s compensation claims, visit my blog here where you can find detailed instructions to deal with each one.

An excellent and low-cost place to receive more resources is to enrol in the “Walk Away From Work Stress” program. Click on the link to receive the free, 3-part video training series and other useful resources too.

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