What Is Workers’ Compensation: Understanding Workers Comp Claims In Connecticut
Be wary of common deceiving industry practices
If you were the CEO of a major insurance company, your compensation would probably be higher than other industry CEOs. Why? These large insurance companies make more money than many other industries.
A recent research study by the American Association for Justice (AAJ), titled “Tricks of the Trade: How Insurance Companies Deny, Delay, Confuse, and Refuse.” This report states how major insurance companies often deny valid claims, delay paying claims until policy owners just give up, discriminate against injured parties, deliberately confuse policyholders, and/or cancel policies so they don’t need to pay legitimate claims.
The following are some Dirty Tricks Insurance Companies play on injured people.
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1. Deny Claims
Some of the most recognizable insurance companies, including Allstate, AIG, and State Farm, have some recorded history playing this dirty trick on valid claimants. According to the AAJ, these and other insurance companies reward their employees for denying legitimate claims, and sometimes terminates employees who refuse to deny valid claims.
The AAJ further says some of these big insurance companies are not above committing obvious fraud to avoid paying claim dollars. That is a strong, potentially brand harming statement, but the American Association for Justice stands by this assertion.
2. Delaying Claim Resolution
When insurance companies believe they cannot get away with denying legitimate claims, they go to Plan B: Delay. These companies bury claimants with paperwork, hoping policy owners will simply give up their fight to get their valid claim paid.
The AAJ notes that some long-term care insurance companies will delay paying claims to older people (most of the long-term care insureds) hoping they will die before they need to pay the valid claim of customers. When this tactic rears its ugly head, your lawyer will earn his/her fee. Attorneys are all-too-familiar with this sleazy policy.
Your lawyer will not stand for this trick. He/she typically threatens the insurance company with filing suit to embarrass the company with a public trial. Insurance companies dislike being in court, as much as they do paying claims.
3. Confusing Policyholders with Language and Fine Print
While the butt of many jokes, the language in insurance policies is deliberately confusing with much ambiguous language and volumes of fine print. Once again, your lawyer will prove his/her knowledge by reading and translating this seemingly foreign language for you, into simple English.
Even many insurance company personnel fail to understand their own contracts. As you now know, the confusing language in insurance contracts is specifically intended to confuse all non-lawyers.
4. Health Insurance Companies Dislike Sick People
Health insurance personnel sometimes receive bonuses if they meet or exceed a company’s so-called “cancellation goals.” When insureds cost the company money, some companies cancel their policies so the bonus money goes to staff vacations or new cars, instead of medical treatment. Considering the expensive premiums for health insurance, you would think insurers would at least pay valid claims.
It’s sad that the insurance company you trust to “have your back,” often turns to shady tactics to avoid paying legitimate claims. Unfortunately, per the AAJ, this is what some major insurers do, regardless of their expensive advertising to the contrary.
Insurers get excited when policy owners do not hire lawyers to manage their claims. Experienced attorneys are aware of the dirty tricks insurers play on policyholders who do not have legal representation. Good lawyers, not subject to insurer intimidation, will fight for your rights to get paid for valid injuries.
What Is Workers’ Compensation
Workers’ compensation insurance is mandated and administered by your state, providing employee compensation when employees who have job-related injuries and/or illnesses must spend recuperative time away from the workplace. Translation: If you get hurt on the job, workers’ comp will reimburse you for your medical bills and pay you for your inability to work.
Each state has its own rules, regulations, and laws covering this mandatory insurance your employer must carry. Fault is not normally an issue; this is an important difference from most auto or liability insurance plans. Since fault is not a problem, your injury caused by you, your employer, one of your coworkers, or, even, a customer.
In most states, there is a tradeoff for these benefits. Most states prohibit your ability to sue your employer for damages for injuries in return for these guaranteed benefits. This coverage pays more than your medical bills, including hospital stays, since it also pays disability payments for your lost wages until you can return to work.
If you need rehab and/or retraining for a different job, workers’ comp will pay for these necessities as well. The medical coverage pays your medical costs to diagnose, as well as treatments for your injuries or illness.
Understanding Workers’ Comp Claims
Many employees who are injured on the job become confused when faced with filing a workers’ compensation claim. At times, employees tend to “freeze,” considering filing a workers’ comp claim a daunting responsibility. Filing a claim is not a daunting task.
Protect yourself by filing a claim as soon as possible after your on-the-job injury. Avoid giving your employer’s workers’ compensation insurance company a reason to deny your claim. Workers’ compensation insurance companies are like all other insurers, they love to collect premiums, but, they dislike paying out claim dollars.
Since each US state sets their own rules and regulations for workers’ compensation insurance, it’s impossible to make general statements that are true for every state in the nation. We’ll focus on Connecticut, since they passed their first workers’ compensation act in 1913, early in the 20th century. The state’s Workers’ Compensation Commission has over 100 years to understand the regulations that have changed since the original workers’ compensation act was passed.
Become familiar with your state’s workers’ compensation regulations. And don’t overlook the statute that stipulates the maximum time to file a claim for benefits. For example, in Connecticut injured employees have one year from the date of their injury or three years from the first symptoms of an occupational disease. Although, generally, many states have a two-year statute of limitations to file claims, in Connecticut you have only one year to file a claim.
Do not confuse filing claims with notifying your employer of an on-the-job injury. You must notify your employer immediately after a workplace injury. Each state has their own form for employer notification, which is then sent to the workers’ comp insurer.
An employee is not expected to be an expert on workers’ compensation, but you should always consult a lawyer with experience managing workers’ compensation cases. The experienced attorney will give the employee wise advice on his/her workers’ comp claim potential.
Timothy C. Moynahan is the CEO and owner of Moynahan Partners, which offers business development consultancy, identifying strategic business partnerships and funding sources. He founded and heads the Moynahan Law Firm, Waterbury, Connecticut, and is “of counsel” to the Jin Law Group at 200 Park Avenue in New York. He is a sought-after and successful trial lawyer, earning the Super Lawyer of New England and Connecticut awards from 2009 to 2012 and Best Criminal Defense Attorney accolade in 2013.