In the vast majority of workers’ compensation claims with significant injuries, the adjuster mislabels the work injury. This is the most common trick that insurance companies play on unsuspecting injured workers. And it’s shameful.

We give so much time and effort to our jobs that what we do for a living often defines who we think we are. And when we work somewhere for any length of time, we are usually showing loyalty to the company and the people we work for. We expect loyalty in return. After all, we often go the extra mile for our employers.

That loyalty is not often reciprocated after a work injury. Especially when an insurance company gets involved. Insurance companies want to collect money for providing insurance, but they sure don’t want to pay any of that money out to people who are supposed to be covered by that insurance.

The easiest way an adjuster can get out of paying benefits in a workers’ compensation claim is to mislabel the work injury. That means that when you have a serious injury on the job, the adjuster labels it as a minor injury. For instance, if you lift a box and end up with a herniated disc with a pinched nerve in your back, the adjuster will say it’s just a sprain. That way they can limit the healthcare you might get and only pay you to be off work for a few days.

We handle these types of cases every day because it’s the most common game that insurance companies play in workers’ compensation claims. The other day we had to go to trial over this very thing. Our client had a job in a warehouse where he often had to lift heavy things to load and unload products on pallets. On the day he got hurt, he had to lift 80 fifty-pound bags to stack them on a pallet. He would lift the bag up to his shoulder and then throw them down on the pallet. While doing this he injured his shoulder.

This guy’s shoulder was hurting so bad that his doctor sent him out for an MRI. The MRI showed that he had a SLAP tear in his shoulder. The insurance company said it’s just a sprain. The adjuster mislabeled the work injury.

Surgery was necessary if he was going to get back to work, so we had to litigate the case to define the injury. This type of issue is called an extent of injury issue. We had to ask a judge to decide whether his injury was just a sprain or was it a SLAP tear.

The insurance company paid Dr. John Obermiller to testify at the hearing. He said that you can’t get a SLAP tear from lifting bags like our injured worker was doing it. Of course, it only takes about 30 seconds of online research to find that acute SLAP tears are often caused by

lifting things, especially if you do it in a jerking motion like you would do to lift something up to your shoulder. The judge said that Dr. Obermiller’s opinion was “sharply inconsistent with the credible evidence.”

Ultimately, the judge ruled that our client’s injury included the SLAP tear, so he was able to have the surgery he needed to get well. We had the right evidence for the judge to make that ruling. In every extent of injury case, you want to have evidence explaining the cause of the correctly labeled injury. If the diagnosis is a SLAP tear, then the evidence needs to explain how the work event caused the SLAP tear. We usually do this with a causation letter. If you want to see what that includes, download our free ebook to get a detailed list of what that needs to include.

If you want to discuss any games the adjusters are playing with you, feel free to reach out any time.