Workers' comp insurance provides workers who have been injured on the job or as a result of work-related duties with compensation while recovering from injury. Workers' compensation laws, such as choice of physician, waiting periods and retroactive pay, vary according to state. These laws, as well as changes to the system, make this type of insurance a particularly complex one for those seeking coverage while injured. However, complaints about the system aren't solely relegated to employees — employers have complaints of their own.
Rejection of Claims by Employers
Among the chief complaints about workers' compensation insurance is the initial denial of employee claims made by employers. The more claims filed, the more employers pay in insurance costs. Thus, in most states, employers require that injured workers be examined by their physicians to determine the extent of their injuries and the employee's ability to return to work. As a result, employer-physician agreements to keep employers from paying on claims have often been a major complaint about workers' comp insurance. These complaints often lead workers to hire workers' comp attorneys to fight for their rights.
False Claims by Employees
In addition to the production employers stand to lose from employees who can't work because of injuries, they also lose a significant amount of money. The National Insurance Crime Bureau reports that approximately 10 percent of all insurance claims — which includes workers' comp claims — are fraudulent. This is corroborated by the Insurance Research Council's report that one in 10 adults has no problem with claiming injuries at home as work-related injuries. This evidence, predatory attorneys, the rising costs for workers' compensation premiums, and the Workers' Compensation Appeals Board have led employers to become more vigilant in working with physicians and insurance carriers to ensure that injuries are legitimate and work-related.
Rejection of Treatment by Insurance Companies
Insurance companies work with employers to provide comprehensive workers' comp services that help to reduce their costs, educate them on the laws pertaining to workers' comp and perform proper risk assessments — e.g., workplace environment and equipment hazards, which employees are most likely to be injured. In an effort to reduce employer costs and protect employer liability, insurance companies may deny injured workers certain forms of treatment by their employer's physician. Consequently, workers are forced to pay for treatment from their own physicians. On the complaints board for Liberty Mutual Insurance, several incidents of injured workers being denied treatment are cited that include the denial of surgical procedures, as well as palliative and curative treatment. Complaints about the denial of care may lead employees to retain attorneys to challenge employers and their insurance companies.