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Workers Compensation Claims Managers: Profiting Through Denials And Delays

Fight Unfair Claims Delays And DenialsThe journal ProPublica previously published an investigative article on the companies who profit by handling workers’ compensation claims. These companies, the middlemen in claims, are largely unknown by the public. After all, they manufacture nothing. They produce nothing. They sell nothing of value to consumers.

The ProPublica article starts with a bizarre scene. Somehow the reporter gained entry into the private Las Vegas conference for these claims managers. This is what he saw:

A scantily clad acrobat dangles from the ceiling, performing flips and splits as machines puff smoke and neon lights bathe the dance floor in turquoise and magenta. Dancers in lingerie gyrate on poles to the booming techno. Actors dressed as aliens pose for selfies with partygoers. There’s an open bar and waiters weave through the crowd passing out chocolate truffles.

It’s the closing night of the National Workers’ Compensation and Disability Conference & Expo.

The party at Light, a Cirque du Soleil-themed club at the Mandalay Bay Resort and Casino, capped off the workers’ comp industry’s biggest annual networking event. For three days in November, hundreds of vendors wooed insurers and employers with lavish after-hours parties, giveaways of designer handbags, photos with Olympic gymnast Kerri Strug, and free rides in orange Hummer limousines.

A top manager for a major insurance company recalled standing amid the hoopla a few years back when a company CEO turned to her and marveled: “All of this because somebody got hurt at work.”

How much money do these claim managers make? While their activities can have a tremendous impact toward the suffering or healing of hurt people, they function with little or no oversight. They are really not regulated. And, the workers’ compensation laws in Alabama and many other states fail to impose proper penalties when they act in bad faith. Want to know how valuable these middlemen are? Last week, I saw an announcement that an investment group had just purchased the majority ownership in Sedgwick for $6.7 Billion. All that money for a company that “manages” claims!

Most people have never heard of Sedgwick. The first time most people hear of Sedgwick (or other claims middlemen) is when they are hurt and trying to receive medical care.

I am familiar with the companies who “manage” workers’ compensation claims. I hear the frustrations voiced by clients on a daily basis when their calls to an adjuster are never returned, when the doctor tells them he cannot get approval for a simple procedure, or their disability checks suddenly stop without warning.

Last month, I filed a motion for sanctions for a client who already has court ordered care. We won her case at trial. We received a court order requiring medical care. This client returned to my office with a medical note from her authorized doctor showing call-after-call from his office to the claims manager in her case seeking care. The doctor’s calls and emails seeking authorization for months — all unreturned by the claims manager.

If you were injured on the job, what does this mean for you? Some injured workers and their attorneys beg these claims managers to rethink their wrongful denials. They also call these claims managers repeatedly for medical care only to be ignored. This rarely helps the injured worker who should be receiving benefits. It usually leads to frustration and continued injury months and years down the road. If you are hurt and have a valid claim, you need a lawyer willing and able to prepare the case for trial.

I could post so many stories of suffering by injured workers. Stories of suffering with no response to calls. Stories of injuries denied for crazy and unlawful reasons. Stories of doctors who give up in frustration over their own requests for treatment or payment that go without response. How much money do workers’ compensation middlemen earn for “claims management?” Who is suffering to produce the “savings” they tout? To me, the answer is obvious. Workers’ compensation should be simple. But, when an industry can afford a private festival of entertainers in Las Vegas, it is not. Perhaps we should look at the middlemen and ask ourselves — Are they profiting by increasing suffering rather than reducing it?

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At the Blackwell Law Firm, we have experience in workers’ compensation trials across Alabama. We understand that preparation and hard work produce the best results for injured clients. If you have questions, consultations are always free and confidential.