When an injured worker has been found to have defrauded a workers’ compensation insurance company, many insurance companies, especially SAIF will do everything in its power to make sure a press release is issued to perpetuate the notion that everybody on workers’ compensation is somehow cheating the system. Of course, the real facts suggest otherwise, showing that only a small percentage of workers’ compensation claimants are actually up to no good.
Something that never seems to have been is the press release showing all of the unreasonable behavior from the insurance companies and claims administrators. In the past several weeks, we have seen to glaring failures; one from an insurance company, and one from a claims administrator.
If an insurance company is going to deny a benefit, it must have at the very least a legitimate doubt about whether the benefit is due. However, in our experience, it is not uncommon for an insurance company to deny benefits without any factual basis to back up the denial. I just completed briefing and argument where an insurance company attempted to orchestrate a claim that the injured worker withheld information. However, when that idea fell through, the insurance company went to another route, only to finally concede that it had nowhere to go, and paid benefits.
In another matter, the insurance company is simply doing nothing. Client is eligible for benefits, but letters and phone calls go unanswered, and the client, eager to get back to work, his left to wait.
The fact of the matter is that this happens every day, and only a small percentage of unreasonable claims practices ever go punished. Even when they do, the penalties are anemic, and do little to deter insurance companies from behaving badly.
If you are mired down in a workers' compensation claim in Oregon, you do have options. Contact the ombudsman's office to learn your rights, and don't be shy about requesting review for penalties. Sometimes, it actually works.
