Tricks Insurance Companies Play (Survival Kit)

Worker’s Compensation:
Tricks Insurance Companies Play

− Jodi Brenner Ginsberg, Georgia Attorney at Law

As an advocate for my clients – employees who have been thrust into the workers’ compensation system – I often find myself asking hard questions to insurance adjusters.  Outside the context of my law practice some of the questions I ask would be considered downright uncomfortable but in my business, I am going to make my opponents uncomfortable if that is what I need to do.

Here’s an example of what I am talking about.  Earlier this year I got a call from one of my work injury clients who told me that his temporary total disability (TTD) checks had stopped coming in the mail.  He had been receiving his TTD checks for several months and the insurance company had not filed any paperwork seeking to terminate benefits.

I immediately called the insurance adjuster who assured me that my client was still in “pay status” in their system and that his checks were being mailed out.  This did not make sense to me because it is highly unlikely that 3 checks would be lost in the mail in consecutive weeks.

Nevertheless I instructed my client to contact his local post office to confirm that there were no issues with mail delivery, and I called the insurance adjuster back to ask for:

• the check date
• the check number
• the amount of payment
• an address confirmation

The adjuster was somewhat put out by my demand for proof but said she would send me a screen capture with this information on it.

Three more days passed and no screen capture or any other information.  The adjuster would not return my call.  I requested a hearing on this issue – the missed TTD payments – and a few days after that I received a call from the defense lawyer who had been retained.  He told me that the adjuster had insisted to him as well that the checks had been issued but that when the adjuster could not provide him proof she admitted that my client’s reserve account had run out and she had failed to confirm that funds were available.

Insurance companies use reserve accounts to fund claims – in this case they set aside funds to cover the TTD benefits, then refill that account every 3 or 4 months.  This system is used to help managers keep control of adjuster conduct.

In our case, the reserve ran out and no one requested a refill.  So the adjuster’s system showed that the case was in pay status but there was no money authorized to be paid.  I am sure that an error message was generated to the adjuster but that is a different issue.

We ended up having the insurance company overnight the missing funds plus a penalty.  My client is once again receiving his checks.   I was able to resolve this problem because:

• the adjuster’s story did not make sense
• I was willing to call her out on her misstatements
• by requesting a hearing I then had the right to schedule a conference call with the judge.  Judges have very little patience for missing TTD checks and by raising the stakes I “encouraged” the defense lawyer to push his client

This is the type of issue that I deal with on a day to day basis and I’d like to think I was able to get a positive resolution quickly because I have been working within the Georgia work injury legal system for over 25 years.

P.S. I hope you find this Survival Kit valuable but I want to emphasize that you should not consider anything in this Kit or on this website as legal advice.  I can only offer legal advice to clients who have hired me by signing a written retainer agreement. So if you would like to learn more about Georgia workers’ compensation law impacts you based on the facts of your case, please call me today.  Thanks!