Hi. This is Brian Wiklendt with Garfinkel Schwartz. I’m coming to you from our Maitland
Florida office which is a suburb of Orlando. I’m lead council here. What I’d like to
do is talk to you a little bit about what insurance companies try to do under the Defense
Base Act to get away with not paying on claims and there are a lot of different things that
they do. It’s really tough to go alone if you don’t know these tricks and you don’t
have an attorney that specializes in the Defense Base Act.
First they try to deny the claim. That’s the first thing that they’re always going
to try to do is deny the claim. They do that in various different ways. First they’re
going to talk about notice. Did you did you give adequate notice to your employer? If
you don’t know what the Defense Base Act is it’s difficult to know what you have
to do and you have to rely on the employer to to to go through the correct process. So
as soon as you get injured you want to talk to the human resources people or your supervisor
and say how how do I do this claim formally? How do I actually get the Department of Labor
to understand and know that I have a claim here? That’s one thing that they try to
do.
Next they try to deny claims based on hiring a person that would be say a nurse case manager
or someone that’s going to try to get you treatment. And they’re working for the insurance
company not you. They’re supposedly helping you get the treatment that you need and monitoring
your medical care so that they can provide it for you but a lot of the time they’re
actually trying to find ways to figure out whether this is actually work related whether
it’s preexisting whether it’s degenerative disc disease instead of an actual traumatic
injury. They’re always trying to put holes into what your what your true nature of your
injury is. And so you want to be aware of that you want to talk to a lawyer about that
you want to see what your how you should interact with these people that are hired by the insurance
company to give medical advice and medical treatment when they may or they may not be
qualified to do so.
They also try to deny claims based on an initial recorded statement. They want to get they
want to send someone out very quickly as fast as they can to try to get a recorded statement
from you without the aid of an attorney or knowing any of your legal rights. I I would
suggest that if if they’re asking for that that you call an attorney right away. You
could always call our office it’s free. I can give advice on that as to how you should
what you should watch out for in a recorded statement. They also do surveillance to try
to deny the claim to say that you’re somehow being dishonest and you’re not really as
injured as you say you are which could which could be an outright denial if if the judge
or someone believed that you were exaggerating or basically flat out misrepresenting what
you can and can’t do under the under the surveillance.
After they try as hard as they can to deny claims once they have to start paying on the
claims that’s a whole other ball of wax and now they’re going to try to reduce whatever
they have to pay whether that be medical treatment that they’re going to claim is unnecessary
meaning that you should have your own doctor. If if someone if someone recommends surgery
you should have a medical opinion regarding why that is so and how they came to that resolution
so that they can’t fight with an independent medical examiner which is what they do in
that circumstance. And they try to find a doctor that’s an independent medical examiner
that they hire and pay to get a favorable medical result for them meaning that the surgery’s
unnecessary maybe injections are unnecessary that that kind of thing to try to avoid paying
the correct medical treatment for the correct medical treatment.
After that it still goes on and on. They’re going to try to reduce your benefits based
on what’s called a labor market survey. Once you get back on your feet they’re going
to try to find jobs around your area that you’re qualified to do that they claim that
you’re qualified to do that you can and that you can also physically or mentally do
as well. A lot of those times it’s we believe that that those jobs some of those jobs or
maybe all those jobs are completely inappropriate for what you can do actually physically or
mentally based on the state that you’re in. They try to find obviously the most expensive
jobs so they can try to reduce your weekly average your weekly compensation benefits.
And they’ll try to do that throughout time. They’ll they’ll keep trying every six
months to a year. They’ll send you to an independent medical examiner or they’ll
they’ll do another labor market survey trying to find jobs that are that they can prove
to a judge that you can do even though you don’t think you can do them. So you want
to make sure you have a lawyer someone that knows how to fight against those types of
things.
They also have functional capacity exams that they they give you to try to to try to get
you to exert yourself so that they can say that you’re actually more healthy than you
are that you can lift up to a certain number of pounds that you can bend over that you
can crouch that you can that you can lift it lift your arms over your head when maybe
you can’t. That’s called a functional capacity evaluation. They use all these things
hand and hand to try to get you back on your feet maybe faster or forever in in terms of
reducing whatever their exposure is on your on your claim.
And like I said they have a vast resource of knowledge experienced people and money
to just constantly and continuously try to reduce your benefits. So it’s just not worth
it in my opinion to go about this alone. Sooner or later they’re going to use one of these
tactics regardless of whether you think they’re doing the right thing or not. Sooner or later
they they will it’s just in their nature.
So again call me anytime it’s free. 24 hours a day we have an answering service and I can
get back to you or someone here can get back to you and give you the advice that you may
need. Again it’s always free to contact the office and ask some questions. If you
when you hire an attorney me for instance for example you wouldn’t have to pay me
I would if I get benefits for you I get paid directly separately from the insurance company
based on my hourly rate.
So if you have any questions regarding this or if you are in the process and you are a
Defense Base Act claimant and these things may or may not be happening to you it’s
always worth it to to get knowledge so that you have enough knowledge to fight against
the insurance company. Again thank you for listening. This is Brian Wiklendt. Good luck
and be safe.