By: Jerry M. Lehocky, Partner

The dictionary definition of insurance is an agreement between a person and a company where, in exchange for regular payment from the individual, the business promises to cover costs in the event of personal injury, death, or of property loss or damage, or similar. Most of us pay into multiple insurance policies under the assumption that if we are the victim of accidental injury, theft, or similar, we will be covered. After all, we did the safe and responsible thing: we made sure we had insurance.

There’s a problem with this belief, however: it’s not how things shake out when it comes to workers’ compensation. “Your insurance will protect you” is one of the biggest myths out there.

While workers’ compensation insurance providers were originally established to provide injured workers with benefits mandated under the Pennsylvania Workers’ Compensation Act (and employers with protection against lawsuits), the reality today is completely different. More often than not, when an injured worker submits a workers’ compensation claim, they are met with an automatic denial.

Why would an insurance company deny a claim if the law – and their own service agreement – requires them to pay benefits? The answer is simple: they’re more concerned about their bottom-line than they are about the injured worker’s welfare. Routine denial and shifting an extensive burden of proof onto the injured worker have become the name of the game.

With premiums paid by your employer and the relative rareness of filed claims, you might think the insurance companies have plenty of profit already – and you’d be right. Additionally, companies can recoup any payments they make or reduce their costs via third parties through practices like subrogation.

By contrast, corporations make it extremely difficult for an injured worker to secure any kind of medical treatment or compensation by bolstering a model of claim denial with complicated paperwork and variety of hoops to jump through. These can include false mandates to treat only with panel doctors, and subjecting injured workers to so-called “independent medical examinations.”

With so many factors working in favor of the insurance companies, it’s important to remember that you’re not alone in facing down these corporations. In a profit-driven industry founded on a model of denial, you deserve someone in your corner. We will fight for your rights every step of the way. If you or a loved one have been injured on the job, contact us today.

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