Insurance Company Tricks to Deny Your Workers' Comp Claim

Workers' comp insurance companies are in the business of minimizing payouts. Their adjusters are trained to find reasons to deny, delay, or reduce claims. Understanding their tactics is the first step to protecting yourself. Here are the most common strategies insurers use — and how to counter them.

Tactic 1: Claiming the Injury Wasn't Work-Related

Insurers frequently argue that your injury occurred outside of work, during a personal activity, or was pre-existing. Counter this by: reporting your injury immediately and describing exactly how it happened, seeking medical treatment right away and telling the doctor the injury is work-related, having coworkers who witnessed the incident document what they saw, and keeping records of all tasks you were performing when injured.

Tactic 2: Disputing Medical Necessity

The insurer may approve initial treatment but deny recommended follow-up care, therapy, surgery, or specialist referrals as "not medically necessary." They use Utilization Review (UR) vendors who routinely deny treatment requests without examining you. Counter this through: the appeals process, independent medical reviews, and if necessary, emergency motions for medical treatment through the workers' comp board.

Tactic 3: Sending You to a Biased IME Doctor

Independent Medical Examinations (IMEs) are often neither independent nor impartial. Insurance companies use the same group of IME physicians repeatedly — doctors who know their income depends on providing opinions favorable to insurers. Counter this by: having an attorney accompany you or send a representative, recording the examination (where allowed), having your own doctor respond to the IME report, and impeaching the IME doctor's credibility at hearing with their track record of pro-insurer opinions.

Tactic 4: Surveillance

Insurers hire private investigators to surveil claimants, hoping to catch them performing activities inconsistent with their claimed limitations. Be aware that you may be watched at any time. This doesn't mean you should fake limitations — it means be honest with your doctors about what you can and cannot do. Surveillance footage showing you doing normal, within-restrictions activities cannot be used against you.

Tactic 5: Social Media Monitoring

Insurance company investigators regularly monitor injured workers' social media accounts. A single photo of you at a party or doing yard work can be used to dispute your injuries. While your claim is open: set all accounts to private, avoid posting anything about your physical activities, be careful about being tagged in others' photos, and assume anything you post publicly will be seen by the insurer.

Tactic 6: Pressuring Early Settlement

Adjusters sometimes contact unrepresented injured workers early in the claim — before they know the full extent of their injuries — and offer quick settlements. These early offers are almost always far below fair value. Never accept a settlement offer before you've reached Maximum Medical Improvement (MMI) and know your permanent impairment level. Once you sign, the case is closed.