Workers’ compensation benefits are not paid by the government. Rather, they are paid to claimants by private workers’ compensation insurance companies. Like all insurance companies, workers’ compensation insurance companies try to pay as few claims as possible in order to maximize their profit margins. Unfortunately for injured workers, that often results in the denial of legitimate claims. The best way to deal with workers’ compensation insurance companies is to hire an experienced workers comp lawyer who can vigorously advocate for the rights of injured workers.
Common Insurance Companies
Not all insurance companies issue workers’ compensation insurance policies. The workers’ compensation insurance industry is, nevertheless, large and lucrative. The following are the top 25 workers’ compensation insurance companies based on 2020 direct premiums written, according to Forbes:
- The Hartford
- Liberty Mutual
- Berkshire Hathaway
- AmTrust Financial
- AF Group
- Old Republic Insurance
- Great American Insurance
- W.R. Berkley Corp.
- State Compensation Insurance Fund
- Texas Mutual Insurance Co.
- Fairfax Financial
- STARR Cos.
- CopperPoint Insurance Companies
- Pinnacol Assurance
- Everest Re
- Eire Insurance
- SAIF Corp.
Our workers’ comp lawyers have experience litigating against many of these companies, plus many more; no matter which workers’ compensation insurance company you’re up against, you can trust that your claim will be in competent hands.
Insurance Company Claim Denials
According to the most recent statistics from the New York Workers’ Compensation Board, about 10% of claims are controverted — meaning that the Board has received a “Notice That Right to Compensation Is Controverted” from an insurer letting them know that the insurer is disputing the claim. That is down from about 12% in both 2020 and 2021. Other sources put the initial denial rate at about 7% nationwide, indicating that the denial rate in New York may be higher than the national average. A controverted claim is one that must proceed to the hearing and appeal stage, which is not an outcome that any claimant wants. If your claim has been denied and you want to move ahead to the hearing and appeal stage, please contact a workers comp lawyer.
Common Issues With Insurance Companies During Claims
It is well-known that insurance companies do not want to pay claims, as paying claims represents a loss for the company. This is as true in the context of workers’ compensation insurance as it is elsewhere in the industry. Workers’ compensation insurance companies use a variety of tactics to avoid paying meritorious claims. Some of the most common are detailed below.
Disputing That Your Injury Is Work-Related
Workers’ compensation insurance companies are only obligated to pay claims for injuries that are work-related. There is, thus, a significant incentive for them to dispute the nature of your injury. For example, they might claim that your work-related injury was caused while commuting to or from work and is, therefore, not work-related. In other cases, they may allege that the evidence you submit — e.g., witness statements, video footage, medical reports, etc. — is insufficient to show a causal link between your work duties and your injury. The insurance company may also allege that you were under the influence of drugs or alcohol at the time the accident occurred.
Downplaying the Extent of Your Injuries
The less severe your injury, the less it will cost the workers’ compensation insurance company in medical benefits and lost wages. Even if insurance companies approve an initial claim, they often try to downplay the severity of claimants’ injuries in order to pay them less than they are entitled to. In some cases, they may require you to undergo an independent medical examination. They may even try to pressure the claimant to return to work before his or her injuries have fully healed.
Failing to Meet Deadlines
The workers’ compensation system in New York operates under strict deadlines, which apply to both employees and employer/insurance companies. For example, claimants must notify their supervisors of injuries within 30 days and file a claim for workers’ compensation benefits within two years. Your employer must notify their insurer within 10 days of receiving the claimant’s notification of injury. The insurance company must then provide the claimant with a Statement of Rights within 14 days of the employer’s notification of injury and if it is disputing the claim, it must file notice to the Board within 18 days of notification of injury. Failure to meet these deadlines can delay and jeopardize a worker’s claim.
Alleging That You Failed to Follow Medical Advice
The goal of workers’ compensation medical benefits is for the worker to achieve maximum improvement and, ideally, return to work. Part of that process is attending medical appointments and complying with medical treatment plans. Unfortunately, workers’ compensation insurance companies may allege that claimants failed to follow medical advice as a pretext to terminate paying their claims.
Lawsuits Against Insurance Companies
Insurance companies are among the most frequently sued entities in the country. According to the Lex Machina 2022 Insurance Litigation Report, there were a record 14,793 suits against insurance companies in 2021 — a 47% increase over the previous five years. Policyholders sue insurance companies for a variety of reasons, including:
- Bad faith behavior
- Denying meritorious claims
- Denying a claim without explanation
- Failing to perform a satisfactory investigation
- Failure to pay all benefits to which the claimant is entitled
- Denying claims based on inaccurate information
While workers’ compensation claimants have the option of suing their insurance providers, they may also choose to pursue their claim through the hearing and appeal process at the New York Workers’ Compensation Board.
Get Help Dealing With Insurance Companies From an Experienced Workers Comp Lawyer
Your employer’s workers’ compensation insurance company is not on your side, but your attorney will be. The best way to ensure that you receive the maximum amount of benefits to which you are entitled is to seek the assistance of an experienced attorney. To get started, please contact a workers comp lawyer at Turley, Redmond & Rosasco by using our online form or by calling us at 877-693-2529 (New York City), 516-745-5666 (Garden City), 631-582-3700 (Ronkonkoma), or 631-399-0400 (Shirley/Riverhead).