Why was my workers comp claim denied? Injured workers ask this question every day, and the right answer is almost always the same: the insurance company doesn’t want to pay. Not you, or anyone else for that matter. Wisconsin’s workers’ compensation system was created by the government and laws regulate it. However, the money paying workers’ compensation benefits and medical bills comes from private insurance companies that are in business to make a profit. Worker’s compensation insurance companies make money by 1) taking in more money in premiums, and 2) paying out less money in claims. Number (2) is most likely the reason your worker’s compensation claim was denied. Its just business.
Of course, simply wanting to not pay is not a legitimate reason to deny a claim, so a case has to be made. But first, the injured worker should be aware that a denial is nothing personal. Most unjustly denied workers’ compensation claims were not denied because of anything the injured worker did or did not do; it has nothing to do with the value of the worker as an employee or a person; it probably has very little to do with the facts of the work accident or the worker’s medical condition. Its just dollars, or more precisely, a number on a computer screen.
McCormick Law Office attorneys get the best results by personalizing the claim. With the help of the doctors and experts, we force the insurance company to deal with you as a person and not write you off as a number on a spreadsheet in the cloud.
There are claims correctly denied because the injury or extent of disability is clearly not work-related. Then there are claims the insurance company pays, but the company will typically just pay the minimum required. But for the vast majority of cases, where its somewhat debatable, the insurance company will come down in its own favor and deny. In other words, if the insurer has 10 factors that determine whether they’ll pay, and the injured worker has nine covered; the company can and will use the one factor to deny and hope the injured worker just goes away. Insurance companies do this using the tool of the IME.
The insurance company doctor, the “independent medical examiner” or IME, will say because there were no witnesses, no accident happened; or the worker’s back condition is degenerative or pre-existing; or the injured worker can return to work with no restrictions. But remember, the IME is not the final word and its nothing personal, its just business. It’s the business of McCormick Law Office to make the worker’s compensation insurance company pay the injured worker what they are supposed to.