8 Workers’ Comp Delay Tactics: What You Need to Know
You’ve suffered a workplace injury, and now you are stuck waiting to receive workers’ compensation benefits. What’s the holdup? Unfortunately, there are a number of common workers’ comp delay tactics that insurance companies use to keep you in limbo.
Many insurance companies drag their feet because paying out money to the victims of workplace injuries is the last thing they want to do. Often, workers’ comp delay tactics come down to the insurance adjuster being lazy, overworked, or untrained.
However, some unscrupulous insurance adjusters seem to use intentional workers’ comp delay tactics in hopes the victim will eventually give up and return to work without receiving the benefits they justly deserve.
If you are unsure whether insurance adjusters are using workers’ comp delay tactics, look through these common examples to see if they sound familiar. Then, find out what you can do about it.
Slowing Down Communication
We’ve all dealt with someone who takes forever responding to a text message, email, or phone call.
While this is annoying when we are talking about a friend or family member, it’s totally unacceptable when it’s a professional that is delaying your medical treatment or your workers’ comp benefits.
Unfortunately, this is one of the common workers’ comp delay tactics.
In some cases, insurance adjusters are simply dealing with huge caseloads and struggling to stay on top of things.
In other cases, the insurance adjuster is lazy or bad at their job. In some cases, yes, it is just plain bad faith on the adjuster’s part.
It is also common for doctors to never hear back from insurance companies after they make a request. The line just goes dead.
No matter the cause, when communication breakdowns happen, it inevitably slows down your treatment or benefits.
Requiring Second Opinions
Another common workers’ comp delay tactic is to require second opinions.
This occurs most often when the workers’ compensation doctor requests approval for surgery.
Rather than granting approval and allowing the victim to have much-needed surgery, the insurance company will require a second opinion in hopes a different doctor won’t make the same costly request.
This whole situation eats up a lot of time, including finding a different doctor, scheduling an appointment, and awaiting results, during which you are still suffering from your workplace injury.
Seeking Information about Your Prior Medical History
Insurance companies will use your pre-existing conditions against you. So, it really shouldn’t come as a surprise that one of the more common workers’ comp delay tactics is seeking information about your prior medical history.
For example, we’ve heard things like, “We heard a rumor that your client had a similar accident before.”
Moreover, the adjuster might poison the well with the doctor we choose by mentioning a prior accident, and the doctor then wants to review the medical records first before agreeing to treat.
While it’s wise for doctors to know your prior medical history, there are times when this is merely a tactic to delay workers’ comp or even to deny it.
Requesting More Information
Workers’ compensation requires a whole lot of information. There are forms upon forms to be filled out.
Insurance adjusters use this as a workers’ comp delay tactic.
Before you are granted approval, they will continue requesting more required information. They’ll ask for one more thing one week, and then, they’ll ask for one more thing the next week.
They have to have all these things before approval is granted, supposedly.
Here’s the truth – insurance adjusters know what types of information they need from you at the very beginning of the claims process. They don’t suddenly remember they need something else from you. It’s a delay tactic and a fishing expedition to find something to use against you.
Waiting to Send Weekly Checks
If you’ve been injured on the job, it means you are often out of work and need medical treatment.
Without the ability to work, you lose an opportunity to make money, which is needed to pay those medical bills.
Unfortunately, we often see delay tactics regarding weekly checks.
Sometimes the insurance company blames the delay in payment on the victim’s employer.
I’ve had clients who have experienced payment delays because, according to the insurance adjuster, there are communication breakdowns between the insurance company and the employer.
Here’s a real-life example: If the client is on light duty, we ask the other side if there is suitable light duty employment. If not, insurance has to pay a weekly TTD (Temporary Total Disability) check. So, the insurance company drags their feet and says, “We still haven’t heard back from the employer about whether they have light duty work,” delaying payment.
Holding Up Prescriptions
Sometimes workers’ comp delay tactics are just a big nuisance, like holding up prescriptions.
I had a client who went to a CVS drive-through after surgery. Insurance approved her pain med, but they had not approved Ambien to help her sleep.
We had to fight that and, fortunately, got it approved the same day.
But her husband had to drive back later that afternoon just to pick up that prescription that should have been approved on the spot.
Some delays are weeks and others are hours, but still a hassle.
Failing to Authorize
One of the most frustrating workers’ comp delay tactics is failing to authorize or approve requests.
Most doctors require pre-authorization from the insurance company before treating a patient.
If the insurance company takes forever to respond to the doctor’s request, this will slow things down.
Sometimes it can be something as small as not getting written authorization that holds up important medical procedures.
Just recently, I received a call from a client as she was literally on a stretcher in the surgery center about to have knee surgery. She told me the doctor’s office had received verbal authorization from the adjuster, but then they realized they didn’t have written authorization.
So, the medical team made her wait until opposing counsel and I could track down the adjuster to get written authorization ASAP.
The adjuster should have done it but failed to until the last minute.
Blaming the Victim
Sadly, one of the worst workers’ comp delay tactics is blaming the victim.
For example, “He or she didn’t provide us with XYZ, so we can’t move on.”
There have been numerous times when clients have provided all the information necessary for a claim only to have the insurance company say they didn’t.
With that being said, keep copies of everything!
How an Attorney Can Help with Workers’ Comp Delay Tactics
When you need medical care and a paycheck, you don’t have time for delays.
That’s where an experienced workers’ compensation attorney can help.
Not only do we understand the ins and outs of workers’ compensation law in Georgia, but we also know how to handle insurance companies.
For instance, Georgia has a Petition for Medical Treatment (PMT) process. Essentially, this is a form an attorney files for an expedited conference call with a workers’ compensation judge regarding a medical issue.
Usually, it’s to push the insurance adjuster to approve a medication, physical therapy, surgery, MRI, or anything medical-related.
However, the teleconference typically doesn’t happen as the insurance adjuster either approves it or files a formal denial (which means we then file for a hearing).
Most of the time, the insurance adjuster approves the medical-related request because it’s something they should have already done, but they were too lazy or overworked and missed it.
Other times, they will approve it because they are afraid to get on a conference call with a judge.
A key difference between those with an attorney and those without is that the insurance company knows a workers’ comp attorney will request a hearing and get a judge, and an individual trying to handle it on their own won’t.
A workers’ compensation attorney knows how to put pressure on insurance adjusters, so they stop dragging their feet and start giving you what you rightly deserve.