By Donna Motley, Vice President of Claims

Recently there have been several stories on local News stations claiming the “injustice” of our current Workers’ Compensation system. Allegations have been made by a well known, local plaintiff attorney, that part of the medical profession conspires with the insurance companies to “deny” Workers’ Compensation claims. And that the doctors are making thousands and thousands of dollars by doing so. It just so happens, this plaintiff attorney, who attends local Union meetings soliciting business, once filed a RICO (Racketeer Influenced and Corrupt Organizations Act) suit against us, as well as against our insured (employer/owner), claims adjuster and medical evaluation doctor. We tried the case in the Workers’ Compensation courts AND WON. We also WON on Appeal. We WON in civil court which was appealed to the Supreme Court who denied the appeal as well. Since the case against us, this attorney continues to file similar cases against other carriers and besmirch insurance companies/carriers and all connected with defending these claims.

The Workers’ Compensation Act (originally written in 1912 and updated in 2010) governs claims handling practices. The Act provides an “exclusive remedy” which means the employee doesn’t have to prove negligence on the part of the employer to obtain benefits. It does not matter that the employee was negligent or knew their job involved certain dangers, they are able to collect benefits. Contrary to televised reports that insurance companies and claims adjusters possess evil powers, with a goal to deny claims and pocket the money, we are bound by the Workers’ Compensation Act. We, also, have attorneys that provide guidance and interpret the Act as well as case law in these matters. The employee cannot sue the employer, BUT they can certainly sue for their Workers’ Compensation benefits! Claims are denied based on the merits of the case. We follow the provisions of the Act. If you have filed a claim with our department, you are probably aware of all the questions we may ask. Would it be easier to just “pay the claim”? Yes, but Workers’ Compensation is not the same as health insurance; this is not a social program. We’ve had employers argue with us that we should pay their claim simply because they pay their premium. We’ve had employers get upset with us because we investigate claims. As a mutual insurance company, we are acting in the best interest of the insured members (which would include the insured’s employees). Unfortunately there are so many people attempting to fraud the system, it ruins the process for everyone. As an employer, if you had to pay the claim out of your own pocket, wouldn’t you want to be sure the claim was legitimate?

As an employer, do you really think you should have to pay someone for life because they have arthritis? As an employer I’m sure you are familiar with the American with Disabilities Act – people with disabilities are fighting to be productive and prove there are jobs they can do – so why can’t a Workers’ Compensation claimant work in some sort of capacity?

Don’t be mislead by what is shown on television. The above referenced plaintiff attorney sends all his clients to the same doctor, who he knows will issue an opinion that the employee is totally disabled! I’ve been in trial with this attorney and when we showed surveillance video of his client trimming trees with his “injured” arm, this attorney badgered his own client (plaintiff), yelling at him in court asking if that was him in the video. It was not a pleasant experience for anyone. Plaintiff’s Bar is gearing up for the pendulum to swing and favor their clients, MTM is ready to take this on.