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News Stories

Filed an Insurance Claim? Beware of These Insurance Tactics

Most businesses are required to obtain workers’ compensation insurance. Companies pay premiums to workers’ compensation insurance companies and, in exchange, benefits are supposed to be paid to workers who sustain injuries or illnesses while working on the job.

But a recent story profiled by the Wall Street Journal has many wondering whether rightful benefits are really being paid. Travelers Cos., a large workers’ company insurance carrier for U.S. businesses, recently disclosed their second quarter profits. The company raked in almost $1 billion in net income-an 85 percent increase from the previous quarter.

Travelers Cos. is just one of many insurance carriers achieving such success. The combined yearly income for the entire insurance industry is in the tens of billions.

But how are these insurance companies able to achieve such high profit margins? Sadly, many companies often utilize various tactics to avoid paying claims as a way to increase their bottom lines.

Here are a few examples:


Many insurance companies simply deny rightful claims in order to boost revenue-even if it means engaging in unlawful or fraudulent conduct. Some carriers have even allegedly rewarded employees who have a successful track record of denying claims. More in premiums and less in payouts equals more revenue.


Many insurance companies have also been known to delay paying out claims and paying medical providers in order to boost profits. In some cases, claimants have been required to fill out overly burdensome paperwork or filing requests. This is done in hopes that they just simply give up on collecting the benefits. Sadly, in some cases, this has worked. Workers’ compensation claimants in particular are often too sick or ill to devote the energy needed to fulfill the taxing requests. Likewise, medical providers on admitted injury accepted claims find themselves unpaid and having to reduce their bills in order to receive any payment at all.


Insurance carriers also have been known to use tactics that confuse claimants. There always seems to be various exceptions, exclusions, and contingencies to their claim which is often very confusing. And sometimes, this is done in order for a carrier to justify denying or delaying a claim.


It is important to note that not all insurance carriers use such tactics and avoid paying out claims; there are some who follow the law and actually do the right thing.

However, all carriers have enormous resources at their disposal. Negotiating or fighting back against a decision made by any insurance company is often no match for an individual claimant-particularly one who is sick or ill because of a work related injury.

Individuals who have filed a workers’ comp claim or been denied a claim should immediately consult with an Orange County workers’ compensation lawyer. An Orange County personal injury attorney who knows the law can provide invaluable advocacy to help make sure all rightful benefits are paid.