Why Workers’ Comp Adjusters Don’t Want You to Get Paid

David Monteleone
Illinois Accident and Wrongful Death Lawyer

  Posted  |  Category : Workers’ Comp Lawyer

workers compWorkers’ compensation began around 1900 as a grand bargain between workers and management. Injured workers agreed to surrender their right to file injury claims in court if management paid for a no-fault insurance system that guaranteed financial benefits.

At first, the arrangement worked well for both sides. Over the years, insurance company interests began to dominate the workers’ compensation process, especially at the workers’ comp adjuster level. As a result, financial benefits have declined steadily over recent years.

In this environment, a workers’ comp lawyer in Rockford is a game-changer. Statistically, benefits awards increase dramatically when injured workers have lawyers. An attorney knows how to guide your claim through the procedural maze this system has become. More importantly, an attorney is a strong advocate for you, in the courtroom and at the negotiating table.

Lost Wages

Insurance companies deny wage claims because, in simple terms, insurance companies only make money when they collect premiums. They lose money when they pay claims.

Frequently, workers’ comp adjusters miscalculate a victim’s average weekly wage, which is the benchmark figure for lost wage replacement.

Commonly, adjusters take a victim’s last five or six paychecks, divide by five or six, and voila, generate the AWW. This calculation is almost always misleading.

Most people change jobs frequently. These job changes almost always involve salary increases. Even if the victim remains on the job, stairstep pay increases and merit-based pay increases are quite common. So, the paychecks victims receive in the future might not be the same as the paychecks they received in the past.

Speaking of future earnings, the AWW must also account for these things. Often overlooked items include missed overtime opportunities and missed performance bonuses. On a related note, the AWW must also account for non-cash compensation, like tuition reimbursement or per diem.

Generally, a Rockford workers’ comp lawyer can obtain two-thirds of the victim’s AWW for the duration of a temporary disability. If that disability is permanent, either completely or partially, a lump sum payment might be available.

Medical Bills

Insurance companies often argue that certain medical bills are not reasonably necessary. They base this argument on healthcare and actuarial charts. In other words, according to an insurance company, an injury like a broken arm costs X dollars to correct, and the victim needs Y physical therapy sessions to regain lost function.

But in the healthcare world, there is no such thing as one size fits all. Not everyone has the same needs or responds to physical therapy in the same way.

For example, a slip-and-fall broken ankle might be relatively easy to correct. Many of these victims don’t even need large casts. A vehicle collision-related broken ankle is often much different. Usually, doctors must use metal parts, like rods and screws, to reconstruct the shattered bone.

Since surgery is so extensive, the victim needs more physical therapy. Progress during physical therapy often is uneven. Patients who seemingly plateau suddenly have breakthroughs. The victim’s personal therapist, not an insurance company chart, is the best source of information in this area.

Generally, injured Illinois workers may choose their own doctors, as well as their own physical therapists. This arrangement helps guarantee that victims get the medical help they need, not the medical help an insurance company is willing to pay for.

Count on a Hard-Hitting Winnebago County Workers’ Compensation Attorney

Injury victims are usually entitled to substantial compensation. For a free consultation with an experienced workers’ comp lawyer in Rockford, contact Fisk & Monteleone, Ltd. by calling 815-315-0574. Virtual, home and hospital visits are available.