There are many lies insurance companies tell injured workers before they are represented by counsel and sneaky tactics they use to reduce or deny benefits that are owed. We wanted to explore and discuss what we believe are the top 5 lies that corrupt insurance companies tell those who have been hurt on the job:
Lie #1: “Before I do anything, I need to take your recorded statement.”
This fallacy is often told to injured workers by a representative of the insurance company immediately after their employer reports the injury. There is nothing in the workers’ compensation statute that requires an injured worker to give a recorded statement to an insurance company.
The insurance company may have an internal policy requiring the statement, but that does not mean the injured worker has to oblige. Failure to give a statement is NOT grounds for a legal denial of a workers’ compensation claim.
In fact, we would recommend against giving a recorded statement for the following reasons:
- If the statement is requested right after the accident, the injured worker may not be the right mind-frame to answer questions regarding the accident. The focus of the injured worker may not be on the question actually asked. Many times, these calls are recorded and later used against an injured worker so paying attention is important.
- This is not part of the formal discovery process and the injured worker does not have the same rights as they would under the Georgia Civil Procedure act. These rights include objecting to the form of the question, deposing witnesses and the employer. The injured worker is giving up rights by agreeing to a recorded statement that they do not have to.
- The adjuster (or whoever is asking the questions) may try and purposefully trick the injured worker during these questions and use them to attempt to deny a claim. They also may give the injured worker bad or wrong advice. Remember, the adjuster works for the insurance company, not the injured worker.
- There is certain information that the injured worker may not want to (or may not need to) divulge. An attorney can discuss this with the injured worker and provide legal advice appropriate to their case. Someone taking a recorded statement will not be advising you of your rights.
We can’t stress this enough:
Providing a recorded statement to an adjuster or representative of the insurance company is not required under Georgia law.
Lie #2: “You have to see and treat with a doctor that we send you to.”
This blatantly false line from the insurance company may be the one that is the most often told. Quite often, the insurance company’s biggest concern after somebody reports an on-the-job injury is not how the injured worker is doing, but rather have they taken a drug test. Even at the very outset of the claim, insurance representatives are looking to find ways to deny the injured individual’s workers’ compensation benefits.
The injured worker is often sent to an industrial clinic in order to have the drug test performed. Some examples of industrial clinics here in Georgia are Concentra, Choice Care, Peachtree Immediate Care and Caduceus. These clinics do not specialize in any specific type of treatment, rather they are more like generalists.
Once at the facility for the drug test, the injured worker is typically told to see the doctor at the same facility. This doctor typically provides a cynical and cursory examination of the injured worker.
Throughout our decades of practice, we have rarely seen an injured worker get appropriate care at one of these industrial clinics.
Injured workers are also told to go to these industrial clinics by their employers. They are often not given a choice of who they can initially see. They are typically told that they have to go to the industrial clinic first because the insurance company requires it.
This is not true.
O.C.G.A.34-9-200 states that an injured worker is entitled to medical treatment if they are injured on the job. They are allowed to see a doctor of their choosing off of the panel of physicians. The panel of physicians must consist of 6 doctors, which must include orthopedic specialists. Nobody can make you see an industrial clinic after you are injured. You are entitled to go directly to an orthopedic specialist.
Lie #3: “You didn’t follow the employer’s proper procedures in notifying them of your injury, so your case is denied.”
Employers often have specific protocols and procedures for reporting an on-the-job injury. These can include notifying a supervisor or workers’ comp coordinator. The process may be discussed during orientation and during safety meetings. Failure to follow them could lead to termination.
Despite all of this, not reporting an on-the-job injury in the exact manner that the employer requested or requires cannot be grounds for a denial of a claim.
Georgia law requires notification to your employer within 30 days of the accident—or you must file an official notice with the State Board of Workers’ Compensation within 1 year of the date of the accident if your employer or the insurance company will not pay for any medical treatment or indemnity benefits.
Notification can be as simple as telling your supervisor or having a co-worker who witnessed the accident do so on your behalf. It does not mean completing the steps that the employer and or insurance company has requested.
Lie #4: “You didn’t work here long enough so cannot bring a claim.”
This one is completely and totally FALSE.
It doesn’t matter how long you work for an employer. If you are hurt in the scope and course of your employment, you can bring a workers’ compensation claim. Period.
This means that if you are hurt during orientation for a job, you can bring a claim. Even if you are in the probationary period, you can bring a claim. We cannot stress this enough:
The amount of time you have worked for your employer is completely and totally irrelevant if you are injured on the job.
We have encountered situations where either the employer or the insurance company has told the injured worker that they must work for at least 1 day, 1 week or even 1 month before they are eligible for workers’ compensation benefits. Workers’ compensation is not like health insurance or short-term disability. It’s a right that employees have the moment they start working for their employer.
The state of Georgia has established the right to workers’ compensation benefits and you are not required to fill out any forms when you start working to ensure that you get it.
Lie #5: “You are an independent contractor and not an employee so cannot bring a claim.”
This one is not a simple lie. It can have some factual elements to it, but it’s not always the whole truth.
Just because an employer says an employee is an independent contractor, does not make it so. Often, an injured worker will hear that because they were given a 1099 tax form by their employer, they are an independent contractor. The employer or the insurance company may even go as far as to say that since no taxes were taken out by the employer, the injured worker was not an employee.
This is not true.
There is a 13-point test that the courts in Georgia have developed to determine if an individual is an employee or an independent contractor. Not a single element of the test is conclusive proof either way. A multitude of factors is considered, such as:
- Who determines the times that the individual is scheduled to work?
- Is the employee paid by the job or by time?
- Who provides the tools for the job?
- Who is the boss on the job?
An administrative law judge makes the ultimate determination if an individual is actually an employee or an independent contractor, not the employer or their insurance company.
Bonus lie: “You do not need to hire an attorney.”
Insisting that an injured worker does not need an attorney is a common refrain, but one that rings hollow. Insurance companies have armies of attorneys working for them. Over time, insurers have honed a system that most benefits the company, not injured workers. It is the job of the insurance company to know the law and utilize every legal loophole to their advantage.
Injured workers can help level the playing field by hiring an attorney. If an attorney cannot assist an injured worker, they typically tell them quickly because they are working on a contingency basis and will not get compensated if they cannot perform a beneficial service to the injured worker.
Our Atlanta attorneys at Gerber & Holder exclusively represent injured workers.
It is our job to act as the protector of the individual who has been hurt on the job. We can help them get medical treatment with appropriate doctors and ensure that they are receiving all the benefits the law allows.
If you have any questions about workers’ compensation, don’t hesitate to contact us today for your free consultation.