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Posted on Thursday, November 27th, 2008 at 11:22 am
In a verdict applauded statewide by workers’ lawyers, a federal jury entered a multi-million dollar award to a Des Moines man whose workers’ compensation claim was arbitrarily denied. For more detail on the case, see the Des Moines Register article. For all the talk about workers’ compensation abuse, the verdict is validation that the analysis of “abuse” of the workers’ compensation system should focus on insurance company claims practices.
Insurance adjusters have a duty to investigate workers’ compensation claims, and to deny a claim only when there is evidence that the injury is not work-related. The opinion of the insurance adjuster is not sufficient; the opinion must be backed up by actual evidence.
Typically, workers’ compensation claims are denied on the ground that the injury was not caused by the work incident alleged. Even if there is evidence that the worker had a similar preexisting condition, the claims adjuster must still seek medical opinion stating whether the injury was caused by the work incident. The way to accomplish this critical aspect of workers’ compensation claims investigation is to obtain a written opinion from the treating doctor. Only then is the insurance company on safe ground to deny a workers’ compensation claim on the ground that the injury was not caused by the work incident. For more information on various workers’ compensation issues, see our workers’ compensation FAQ.