Wrongfully Denied: How Insurance Companies Look Out for Themselves
Wrongfully Denied: How Insurance Companies Look Out for Themselves
When people are injured on the job, the standard operating procedure is to:
1- Have the injured worker report the accident to their employer
2- The employer must then fill out an accident report
3- The employer then sends the injured worker for medical treatment.
When an employer files a workers’ compensation claim with the insurance company, this does not mean the employees claim is automatically approved. This can be the case, even with a legitimate accident. Insurance companies are always looking to save money, despite the fact that they are in business to pay for employee’s medical, hospital, and lost wages when they are hurt on the job. Employees need to be aware of how insurance companies often wrongfully deny workers’ compensation insurance claims. Remember that they are only looking out for their own best interests, not the employees.
Workers’ compensation insurance companies hire risk managers to find things in a claim that will lead to a denial in workers’ compensation benefits for the employee. This is the sole job of a risk manager employed at a workers’ compensation insurance company. Risk managers know what to look for when they process workers’ compensation claims so they can deny them. This is the case with insurance companies across the world, not just in Denver. Believe it or not, there is one privately-owned insurance company that saved over $300 million over the last seven years by denying workers’ compensation claims. They make it incredibly difficult for hurt workers to get approved for workers’ compensation benefits so their bottom line looks better and their wallets (or those of their investors) get fatter. One workers’ compensation insurance company uses an 11 point system to help deny and reduce workers’ compensation claim payouts.
Risk managers at workers’ compensation insurance companies do the same kinds of investigations as the worker’s employer does, but they take it a few steps further. Workers’ compensation risk managers look at all the data presented to them about the injuries and the accident, and they ask a lot of “Why?” questions that relate to the law and the system. They also set benchmarks and goals for their investigators, attorneys, and adjustors. Every workers’ compensation claim has a price tag that looks at how the claim is going to end up.
Your doctor may claim you are injured, but remember that risk managers take the causation of the injury further, in that they do not always take the doctor’s word for it. Their job is to look for ways to deny the claim. Lower your risk of having your claim denied or reduced by being aware of the several known ways workers’ compensation benefits get wrongfully denied. Examples of some of the situations that have resulted in the denial or reduction of a claim are:
Am employer’s failure to pay their monthly premiums
A judge made an error in awarding lawyer fees based on their hourly rate
Narrow scopes of releasing workers’ compensation cases that allow discrimination
Medicaid’s payment is a write-off that erases the employer’s liability to their employees
Another thing you should be aware of is that risk managers also look at claims to determine if fraud was committed. They are on alert for workers who pretend to be injured with the intention of filing for disability. Insurance companies do thorough investigations on the injured employees, such as making sure the Social Security number checks out right with the SSA. There have been times when workers’ compensation insurance companies find that the Social Security numbers do not match the employee, so they deny the claim even when the employee is rightfully injured. They will also want to hear witness statements that were involved or next to where the employee was injured to see if the employee was intentionally injuring themselves with the intent of getting workers’ compensation benefits.
Were you injured on the job? Do you believe your workers’ compensation claim was wrongfully denied? Kaplan Morrell help their clients on a daily basis with the issues you have learned. We can help you get the benefits you deserve.
The UK Divorce Process Explained
Deciding to pursue a divorce can be a daunting challenge, fraught with a range of perils. There are a lot of things to consider, such how the divorce process works, what you’re entitled to and who gets the rights to any children you may have.
In order to get a divorce, you will have to undertake a range of steps in order to come to an agreement with your partner. These include your reasons for divorce, which of you will take care of the children and how you’ll split up your money, property and possessions.
One of the first ports when considering a divorce is hiring legal help. You may consider hiring divorce solicitors in Kent, or wherever you are based, who will act on your behalf in divorce proceedings.
The good news is that if you and your spouse agree on these points then the divorce process can be completed in as quickly as 4 months. If not, then divorce proceedings can drag on for much longer.
There are four formal stages to divorce in the UK:
Establishing the grounds for divorce
Filing a divorce petition
Applying for ‘decree nisi’
Getting a decree absolute
You can only divorce under UK law if your marriage has ‘irretrievably’ broken down and you have been married for a least a year. You will be required to prove this to the court by relaying the ‘facts’ of why your marriage has ended. These facts can include reasons such as adultery, unreasonable behaviour and desertion.
To start divorce proceedings you will need to fill out three copies of a D8 form, also known as a ‘divorce petition’. You will also have to pay a fee of £340, but you could be entitled to a discount if you have a low income or are on benefits. Once the forms are completed, you will need to send them to the court.
A notice of divorce will then eventually be served to your husband/wife. Your partner can then choose to either accept or argue against the divorce. If your spouse chooses to fight against the divorce then proceedings can be delayed significantly. If no agreement can be made then this is where divorce solicitors will step in to negotiate with your partner to try to reach an agreement.
Once you both agree on the divorce you can then apply for a ‘decree nisi’ – a document from the court which says that it can’t see any reason why you can’t divorce. A judge will consider whether there is enough evidence to allow the divorce to proceed and review all your paperwork, such as any arrangements you’re proposing for your children.
If the judge gives permission for the divorce to continue then you are able to apply for a ‘decree absolute’ 6 weeks after you have been issued with your decree nisi. Once you have the decree absolute, you are officially divorced.
Five Responses to Disadvantages of Legal Outsourcing
While there are serious challenges to outsourcing your legal services, sending your work to Israel is different. Following is a list of five disadvantages to legal outsourcing and responses to them.
1. Communication Barriers: When a corporation or law firm is outsourcing legal services across the sea, effective communication is crucial. Although many in India and The Philippines speak English, breakdowns may occur because English is not the offshore company’s first language. Strong accents may impede understanding between the company and outsourcing company. More important, a lawyer whose first language is not English may inaccurately tag documents because he does not understand the English – especially since many documents to be analyzed today are emails which contain slang or cultural references.
Answer: When outsourcing to Israel your legal services, you completely eliminate this disadvantage because Israel has a pool of English speaking attorneys who were educated in U.S. law schools and practiced in U.S. law firms. Exact Legal Review’s attorneys are licensed U.S. attorneys who have relocated to Israel.
2. Quality: It is often expected that quality will be compromised when outsourcing legal services. It is known that one major law firm was sued by a client because of privileged information being improperly tagged by a document review company. When using lawyers who were educated in other countries about foreign legal systems, a firm or company may be exposing itself to risks. Answer: Hundreds of U.S. licensed attorneys with decades of U.S. law firm experience currently reside in Israel. Employing such a seasoned team of lawyers is only an advantage because the quality of review is at the very least equal, if not greater, than using in-house attorneys.
3. Loss of Control: A common reason for not outsourcing is allowing someone thousands of miles away under a different roof to complete your work for you. Although you might be managing the operations, you are not the day-to-day supervisor. Many companies cannot relinquish their authority.
Answer: With a professional background of sales and customer service as well as law, Jonathan Easton of Exact Legal Review places client satisfaction as a priority. He will work with you in defining the parameters of the review and creating the guidelines for the reviewers before the document review process begins.
4. Privacy and Security Concerns: Corporations and law firms are understandably hesitant to send sensitive or confidential information around the world. Some argue that when sending legal work overseas is a waiver of attorney-client privilege.
Answer: Because document review is usually completed by a reviewer logging into a secured electronic discovery site, there is no difference whether the reviewer is working from Tel Aviv or Manhattan. Exact Legal Review works with an internet security company to make every effort to protect your security and confidentiality. In addition, non-disclosure agreements will be assigned by every employee involved in a document review project.
5. Hidden Costs of Outsourcing: A common objection to outsourcing is that it does not really save money because you have to send managers overseas to monitor work production and hire attorneys to review the quality of work.
Answer: Exact Legal Review has in place strict quality control measures review of all work completed by its attorneys so there is no hidden expense for a client to implement his own quality control steps. Moreover, before executing any document review agreement, Exact Legal Review will formulate a satisfactory medium of communication to eliminate any need for the client to travel overseas.
In summary, many object to legal outsourcing by saying: “I cannot afford to outsource my legal services.” In truth, living in a tight economic time and corporate law firms charging $500 -$800 per hour, you cannot afford to NOT outsource your legal services.
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