As a policy holder, can I sue my Workcomp carrier for mishandling a case and doubling my comp premium for the next 3 years?

Asked 7 months ago - South Elgin, IL

My company has had a great safety record over the years. We had an employee walking on a jobsite and his knee went out. Long story short - he has been out of work for two years and can no longer work in the industry. This case was mishandled by the carrier attempting to save money on the claim to the point of damaging the workers ability to work.

Attorney answers (2)

  1. Charles Joseph Michael Candiano

    Pro

    Contributor Level 20

    1

    Lawyer agrees

    Answered . I agree with Mr. Hoffman and I would add the following.

    Any injury which resulted from his knee "going out" is absolutely NOT compensable UNLESS the condition that caused it to go out was the result of a work injury.

    If it was a properly compensable injury, you could certainly have monitored what the insurance company was doing. In my representation of injured Workers, I see routinely observe defense attorneys engage in behavior that is calculated with one goal - to optimize their fee. This strategy is absolutely contrary to the WC Act's goal of expedient handling of WC cases and minimizing costs.

    Believe me, I sympathize with you. Much of this stems from insurance adjusters who are too insecure to make the decisions they are paid to make. They cover this ineptness by referring almost everything to defense counsel who immediately reinforce that they did the right thing. Before you know what happened, the $1500 MRI or the $2500 in PT is delayed by 6 months (but then paid by a Commission Order), the attorney fees exceed the cost of the questioned test or therapy and you've wasted $15,000 to $31,000 on ADDITIONAL TTD. Worse still, if the injury's repair is time-sensitive, you have stacked the odd AGAINST a good outcome, thereby serving destroy the worker's career and exponentially increase the cost of the claim.

    Even when an experienced adjuster is handling a claim, many insurance companies have computer programs that trigger some of the new Workers' Compensation "reforms." In this scenario, EVERY request for ANY medical care that is not statistically warranted by the primary diagnosis code (remember this is a machine so nothing the doctor wrote has anything to do with it) is denied pending Utilization Review (UR). This is far and away the biggest scam ever incorporated into any legislation. Under UR, all treatment is placed on hold while a doctor who has never seen the patient reviews the request for treatment. This is all done behind the lawyer's backs. NEITHER attorney needs to be notified and Petitioner's attorney NEVER is. UR requires communication between the reviewing doctor and the ordering doctor so the ordering doctor can defend his request. If the UR physician is trying to reach a surgeon, you can imagine how thrilled the surgeon is to defend his treatment orders for his own patient to a doctor who never saw the patient. All the while - you guessed it - the TTD continues to be paid. When UR is triggered for anything less expensive than surgery, there is an iron-clad guarantee that NO SAVINGS ARE EVEN POSSIBLE. In the face of this gross waste, the legislature slashed compensation to doctors by a fill 1/3, just last year.

    I implore you to think about this AND your own, personal experiences the next time you consider a donation the chamber of commerce or any other organization that pretends to lobby for WC reform. As enacted, WC reform serves only to penalize injured workers and the doctors who tend to them while lining the pockets of those who run such things as UR.

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  2. Stephen Laurence Hoffman

    Pro

    Contributor Level 20

    Answered . Direct suits against insurers are only allowed in specific situations in Illinois, and what you describe is not one of them.

    Best option is switch carriers.

    This answer posted on Avvo is for informational and educational purposes only. There is no attorney-client... more

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