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Is Your Insurance Company Looking Out for You or for Their Profits?

I have been practicing workers’ compensation law for more than 10 years and am Board Certified as a North Carolina Worker’s Compensation Specialist. Clients and prospective clients ask me all the time, “Can I trust the worker’s compensation insurance company?”

Can You Trust Your Insurance Company?

When I am asked this question, it is typically because the insurance adjuster or the employer that is responsible for providing workers’ compensation benefits to an injured worker has been exceedingly pleasant and easy to work within the workers’ compensation claim – up to a point. In that situation, my prospective client believes that the insurance company is working in their best interests. However, I have to remind them of a basic fact about insurance companies. The majority of insurance companies are for-profit businesses. I believe that for any insurance company seeking a profit, their primary motivation is probably that profit and not the insurance claimant. As such, even though an insurance company can be very pleasant to work with at times in a workers’ compensation matter, they may ultimately be more interested in doing what is best for their company.

If you have not read the book Delay Deny Defend by Rutgers School of Law Professor, Jay M. Feinman, it describes many of their devious tactics and truly bad behavior most people don’t know about. We believe every person who buys insurance should read this book. Delay Deny Defend offers this shocking but factual observation about claim payouts:

“A classic text used to train adjusters, James Markham’s The Claims Environment, states the principle: The essential function of a claim department is to fulfill the insurance company’s promise, as set forth in the insurance policy… The claim function should ensure the prompt, fair, and efficient delivery of this promise.

Beginning in the 1990s, many major insurance companies reconsidered this understanding of the claims process. The insight was simple. An insurance company’s greatest expense is what it pays out in claims. If it pays out less in claims, it keeps more in profits. Therefore, the claims department became a profit center rather than the place that kept the company’s promise.

All insurance companies have an incentive to chisel their customers in order to increase profits. Unum, the largest seller of disability and long-term care insurance in the United States, became notorious for failing to pay what it owed to sick or injured workers. Numerous courts castigated the company for unscrupulous tactics, nonsensical legal arguments, and lack of objectivity amounting to bad faith in denying claims.

Employees who were especially aggressive in denying claims were recognized with the company’s “Hungry Vulture Award.”

Delay Deny Defend Tactics We Have Witnessed

We have seen so much bad behavior from some insurance companies, we produced our own booklet entitled Insurance Companies (and others) Behaving Badly. Here is one story from the booklet that shows how one of our paralegals discovered a very underhanded and ugly way a workers’ comp adjuster tried to save the insurance company money.

“I began working on a project that required me to delve into the case notes of clients who had suffered burn injuries. I remember reading the notes on a particular case and I was absolutely shocked at the insurance company’s aggressive efforts to keep our client from getting prescriptions filled or seeing the doctor. The height of disgust for me was when I read how the insurance company tried to force our client back to work, even though her doctors said she wasn’t ready yet. After reading her case notes, I realized how ugly some insurance adjusters are capable of behaving. Clients should never have to take that, and we will do everything we can to stop it.”

Sadly, you simply cannot trust some insurance companies to act in your best interest. Too much money is at stake.

The Real Reason Adjusters Say You Shouldn’t Hire an Attorney

I have had clients tell me that an insurance adjuster told them that hiring an attorney will only hurt their case and the attorney will only be seeking to take money out of their pocket. I understand why some insurance companies would make such a claim, given their profit motives. They do not want an attorney to become involved. Why? Because they know we are potentially able to point out deficiencies in the way they are assisting in the claim or any additional benefits the injured worker may be entitled to that the insurance company may not be providing in the claim.

When an injured worker has an attorney who can try to make sure they receive what they may be entitled to, then that can affect an insurance company’s bottom line – and not for the better. Insurance companies are keenly aware of this.

In short, it would be prudent to be highly suspicious of trusting an insurance company whose main goal is profit. Some are going to be motivated to speak with an injured worker in the manner that best meets that goal. Despite what they might otherwise say to an injured worker, many are ultimately interested in what is best for the insurance company and only the insurance company.

Why Choose James Scott Farrin Workers’ Comp Attorneys?

Our firm was named one of the “Best Law Firms” for workers’ compensation by U.S. News – Best Lawyers® for the greater Raleigh area in 2018.3 That doesn’t happen by accident. Who is on our workers’ compensation team?

Former defense attorneys and paralegals for insurance companies who have worked inside the insurance companies (they know what you’re up against).

More than half our workers’ comp attorneys are NC Board Certified Specialists in Workers’ Compensation law. This is an NC State Bar certification denoting a high level of proficiency in a particular practice area. Of the more than 28,000 attorneys licensed in North Carolina, less than 1% (148) of them are North Carolina board certified specialists in workers’ compensation law.4

We have a former North Carolina Industrial Commissioner Deputy Commissioner and Special Deputy Commissioner. The North Carolina Industrial Commission (NCIC) is the impartial agency that administers and enforces workers’ compensation laws.

We have a former North Carolina State Senator who was elected to serve four terms. He also helped write some of North Carolina’s workers’ compensation laws.

Two of our NC Workers Compensation Attorneys have received coveted awards for workers’ compensation, including Best Lawyers “Best Lawyer” and NC Super Lawyers Magazine’s “Rising Star.”3 One was named NC Super Lawyers Magazine’s “Super Lawyer” three times and Best Lawyers “Lawyer of the Year” for Raleigh twice.3

Our attorneys join your side because they are advocates for those without a voice. And that is often the injured worker. Of our 13 workers’ comp attorneys, 12 are members of the North Carolina Advocates for Justice, an organization dedicated to improving the quality of legal representation in our state. Many are active members in their communities – from teaching at local colleges, to counseling the Hispanic/Latino community.

NC Workers’ Compensation Lawyers Offer FREE Case Evaluation

All of our attorneys are advocates dedicated to fighting tooth and nail for each and every client to try to make sure you get the compensation and benefits you may be entitled to under the law. Insurance companies don’t like attorneys like us because they suspect we will find out how they may be working against you. And we often do.

Contact us today or call 1-866-900-7078.

 

3For more information regarding the standards for inclusion for “Best Law Firms” visit www.usnews.com; “Best Lawyers” and “Lawyer of the Year” visit www.bestlawyers.com; “Rising Star” and “Super Lawyers” visit www.superlawyers.com.

  • “Best Lawyers”: Matthew Healey, 2013–2018; Barry Jennings, 2015–2018.
  • “Lawyer of the Year”: Matthew Healey, 2015 and 2017.
  • “Rising Star”: Matthew Healey, 2010–2013; Barry Jennings, 2011–2013.
  • “Super Lawyer”: Matthew Healey, 2014–2016.

4Figures from the N.C. State Bar as of December 31, 2017.