Workers’ compensation provides vital protection and support for employees injured on the job. However, dealing with insurance companies can often turn into a frustrating battle for injured workers seeking the benefits they deserve.
Far too frequently, insurers use underhanded tactics to stall and stonewall legitimate claims.
In this blog post, we will shed light on some of the most common strategies insurance companies use to unfairly delay workers’ compensation cases. Understanding these questionable techniques is the first step toward guarding against them.
Our workers’ comp lawyers outline five of the top tricks insurers use to avoid paying out claims in a timely manner.
Tactic 1: Death By Starvation
Insurance companies have multiple tactics to draw out a case called death by starvation. They know that injured people need to pay the rent, buy food, and care for their families. If they can starve out the injured worker, the worker will be forced to return to work if they have little to no money coming in.
Tactic 2: Accepting a Case Without Prejudice
In New York State, an insurance company can accept a case without prejudice, which was meant to allow the employer to accept the case and get a little bit more time to investigate it. However, they use it as a sword because that acceptance gives them up to one year to make a final decision.
Until your employer decides to accept or not accept your case, the Workers Compensation Board will not give you a hearing to make a decision, even though there is nothing in the law that states a case accepted without prejudice cannot have a hearing.
Unfortunately, the workers’ compensation board doesn’t always follow the law.
The injured worker may have to wait six to seven months without getting paid or getting paid the minimum of $150 per week. The state will leave insurance companies alone if they at least pay you the state minimum rate of $150.
Tactic 3: Sending You to an Independent Medical Examination (IME) Doctor
Another delay tactic is to send you to an Independent Medical Examination (IME) doctor. The insurance company hires the doctors knowing they will say there’s nothing wrong or only something minimally wrong with the injured worker, whether or not it is true.
Once the insurance company receives a no-disability report from one of their doctors, they can stop payments as long as a judge has not directed them. The average time it takes for an injured worker to get a hearing before a judge is a minimum of eight weeks, but it can be as long as twenty weeks.
Tactic 4: Raising Frivolous Issues
Insurance companies will also raise frivolous issues if the claimant has had a prior injury. Maybe you, the claimant, state, “Yes, I did have a prior injury. But I was working full-time, full duty for 10 years since that motor vehicle accident that injured my ankle.” The insurance company will still claim your injury was due to that decade-old car accident.
Why don’t you?Free Case Consultation
Tactic 5: Taking Appeals
The insurance company will also take appeals, which can take 12 to 18 months to be decided. When they take your appeal of a judge’s decision, they don’t have any responsibility to pay you, the injured worker. If they lose, it’s only a $50 penalty.
During the 12 to 18 months, the insurance company does not have to make any payments to you. They’re able to earn interest on the money that should be paid to you, the injured worker, which means they do not suffer any loss if they take the appeal.
How Workers’ Compensation Benefits Are Calculated in NY
In the state of New York, workers’ compensation benefits are calculated based on the injured workers’ payroll for the 52 weeks prior to the date of the accident. If the injured worker gets a big raise two weeks before the accident, the worker does not get paid based on that new rate but on the average of the 52 weeks prior.
There are many different ways that the average weekly wage can be calculated.
While it may seem like it’s a simple calculation, it is not. If an injured worker only worked 12 weeks, not 52, before the injury, oftentimes insurance companies will base the average on the 12 weeks. However, you are entitled to have the calculation based on the payroll of a similar worker for 52 weeks.
Setting an average weekly wage is complex but one of the most important things that is done in a workers’ compensation case. Once the average weekly wage is set, that is how they decide the injured workers’ benefits.
The multiples depend on the workers’ schedule:
- 260 multiple: Full-time, 5-day worker
- 300 multiple: Full-time, 6-day worker
- 200 multiple: Part-time worker
For example, say you have worked 230 days. The judge can decide to use the 200 multiple for 230 days. This means you’ll get less benefits than using the 260 multiple. If you worked for 235 days, the multiple increases to 260.
| Multiple | Weekly Income | 100% Disability | 50% Disability | 25% Disability |
|---|---|---|---|---|
| 260 | $900 | $600 | $300 | $150 |
| 200 | $600 | $400 | $200 | $150* |
*In New York State, disability wages cannot be less than $150.
In the state of New York, the threshold for total disability is set high. If you’re not a paraplegic or quadriplegic, you’re not going to be found to have a total disability for long. Insurance companies will look to cut your benefits as soon as they can.
For more information on Workers’ Compensation Issues In New York, an initial consultation is your next best step. Get the information and legal answers you are seeking by contacting us today.
