Insurance companies are in the business of taking in our premium payments and doing whatever they can within the confines of the law to avoid paying out on claims. If you don’t like that, your only option is to change what is considered “the confines of the law”, and to do that, you should be reading your legislator’s blog, not your lawyer’s.
You were hurt on the job and your doctor has now given you an order to remain off work. The law says that the insurance company has to pay you as long as you are ordered off work. Getting paid not to work sounds too good to be true, and that’s because it is. You can trust that from the moment the insurance company starts paying you to be off work, they are looking for a reason to stop paying you.
First, the insurance company needs to be aware that you have been ordered to remain off work. That means that they need to see the actual doctor’s order bearing that doctor’s signature telling you to remain off work. Also, they need to see why, by that, I mean they need to see the medical record the doctor created explaining in detail why you deserve an order off work. The order itself is often just a piece of paper, but the medical record can be multiple pages, with one portion explaining your subjective complaints, one portion documenting the doctor’s findings during his or her examination of you, one portion documenting the doctor’s interpretation of your X-rays, MRIs, or other imaging, one portion documenting the doctor’s overall impression or assessment, and the final portion documenting the treatment recommendations the doctor is making. Also, there needs to be some sort of end point, e.g., remain off work until you are re-evaluated at your next appointment on (insert date). Unless you are the victim of some unspeakable horror, i.e. something that made the local news, no one will honor or believe an order to remain off work indefinitely.
Also, remember that proof is evidence that is compelling not just to someone who is already on your side, but rather compelling even to someone who is your adversary. How can you prove that the insurance company received the above information? Do you have the name and contact information of the person to whom it was sent? Do you know the date, time, and manner in which it was sent? How will you expose the insurance adjuster if he or she lies about not receiving it? The best way is to get an email address and/or fax number of the insurance adjuster, scan the materials into a PDF, and email/fax them to the insurance company, copying your attorney on the email/fax. Then retain a copy of the email/fax return receipt until you receive your check.
Isn’t this what I’m paying an attorney to do? Of course not. I’m not going to drive you to your doctor’s appointments either. If you need my staff’s help, (you shouldn’t), we are happy to accommodate you. Just bring the doctor’s order and medical records to our office.
Isn’t your doctor supposed to send this information to the insurance company so they can get their medical bill paid? Typically yes, but they’re not the ones missing rent payments if it gets overlooked.
Also, unless you are maimed for life, don’t get too used to being off work. Eventually, the insurance company will send you to their own doctor who will be much less sympathetic than your doctor, mostly due to the fact that he or she is being paid large sums to be sympathetic to the insurance company rather than you. Undoubtedly, this doctor will write a report that you are able to return to work. The law permits them to do so. Once the insurance company has this report, they will refuse to pay you to be off work any more.
At the end of the day, the responsibility falls on you and you alone to ensure that this is done properly. Besides, if you’re not working, you have eight (more like twelve) more free hours in the day than either your doctor or attorney. Don’t expect a lot of sympathy.
Don’t have a computer and scanner to accomplish all of this? There are over 80 public libraries in the Chicago city limits and one in almost every suburb. The librarians there are typically eager to help you.
Has an insurance company nonetheless withheld payment wrongfully? This happens all the time too. Again, it is up to you to prove that you were in fact wrongfully denied payment. You must prove when you received payments, when you didn’t, the amount you were wrongfully denied, and how you made the insurance company aware of their obligation to pay you. Keep 100% of your documents. If the issue arises, then send them to your attorney.
Insurance companies will fight you every step of the way. If they didn’t, my profession would not exist.
Spencer Law Blog 