The insurance company for your employer is not your friend. If you are injured at work, you need to understand the ways the insurance company will try to defeat your work injury claim. They’ll try to say you weren’t really hurt. They’ll try to force you back before you’re ready. They’ll claim that you’re malingering, and ineligible for benefits.
Injured workers in Chicago are entitled to file a workers’ compensation claim if they are hurt in the course of their job duties, or develop an illness related to the scope of their employment. Workplace benefits include payment of all your reasonably necessary medical bills and 2/3 of your average weekly wages while you can’t work. The insurance company doesn’t want to pay these bills – especially if you need to treat with physical therapists, occupational therapists, or other types of therapists. They want you to return to work as quickly as possible, often before you’re physically healthy.
At Gainsberg Law, our Chicago workers’ compensation lawyers anticipate the strategies employers and their carriers try to contest your right to coverage. Here are a few of their perfectly legal tactics you need to consider:
Hiring investigators to find “proof” you’re not injured
Employers may hire private investigators to follow you and to speak with coworkers and friends. The purpose of the investigation is to catch you doing things that aren’t consistent with your injuries. Within limits, investigators do have the right to review your activities – provided they don’t trespass or violate any federal, state, or local laws.
Investigators for insurance companies may take pictures of you (with zoom cameras from far away). They may take videos. Again, there are limits. Investigators can’t enter your home without your express permission. They can’t violate the law.
Building an “alternative” narrative about you based on your social media posts
Investigators will review your social media accounts. They’re looking for anything that shows you’re healthy even when you’re continuing your medical care. Investigators will review your Facebook accounts, Twitter, Instagram, and any other accounts to check up on you. If they see a picture or text that shows you’re healthy or that you can return to work – they will provide the insurance carrier with this documentation.
As with other attempts to attack your credibility, there are limits. The investigator can only access the items you make public on your social media account. Investigators cannot enter passwords or logins without your authority. They can’t use fraud to try to access your accounts.
It is important to note that your communications with coworkers or management are probably not considered private unless you create the correct boundaries. It’s also important to speak with your family and friends about social media postings. As a general rule, while your Chicago workers’ compensation case is open, you should avoid using social media as much as possible.
Using nurse case managers to show you’re not following the doctor’s orders
Employers will often assign a nurse case manager to your medical case. Employers will claim that these managers are just there to help you make sure you make all your doctor appointments, take your medications, and continue with therapy. Nurse case managers work for the employer’s insurance companies. They’re looking to show that you’re actually not following through with the medical advice your doctors give you, that you’re not following the therapy recommendations you need, and are not doing everything you can to get healthy.
There are limits on what nurse case managers can do. Nurse case managers do not have the right to be in the examination with you and your doctor. They don’t have the direct right to review your medical reports or records. Our seasoned work injury lawyers explain what nurse case managers can and can’t do. You need to know when you have the right to tell the nurse case manager your medical issues are between you and your doctor.
Blaming pre-existing conditions
Insurance companies are suspicious of everything. If you have back pain, a sore neck, soft tissue injuries, a broken arm, a repetitive stress injury, or any injury, they will try to show that you had the injury before your workplace accident. They’ll try to show that your injuries are pre-existing – that they predate your current injuries. If your injuries are due to prior accidents, your workers’ compensation insurance benefits could be denied.
There are defenses for this. Even if you did have a prior injury due to a prior event, you have the right to show that your recent workplace accident aggravated your injuries. You have the right to treat injuries that have become worse due to a workplace accident. Your doctors will need to verify that an aggravation did occur. Your doctors will normally also need to show the extent of the aggravation. Some adjustments to your benefits may (or may not) be justified depending on how much the new accident aggravated an old condition.
We work with your doctors and prior doctors to show that your prior injuries fully healed and that your new injuries require medical treatment and rehabilitation. The burden is on the employer, not you, to prove you have a pre-existing condition.
There is no need to prove negligence in workers’ compensation cases. Still, you need to be careful. If you have medical appointments, you should keep them. If you have a prior injury, you should let your lawyer know about the injury. If you use social media, either stop using it or make sure nothing is posted that could hurt your case. Know that investigators may be watching you. To discuss what steps insurance companies may be taking to hurt your case, talk with your Chicago work injury lawyer. Call Gainsberg Law today at 312.600.9585 or use our contact form to schedule an appointment
Neal S. Gainsberg has spent the last 20 years fighting to protect the rights of the injured in Chicago and throughout Illinois. From consumer rights and bankruptcy to catastrophic injuries and wrongful death, Mr. Gainsberg stands up to large corporations, insurance companies, creditors and hospital administrators to ensure that his clients’ futures are safe and secure. Learn More