Idaho Law Blog
By Fred Lewis and George Casper
As we have touched on in previous entries, there are times when an injured worker’s claim for worker’s compensation benefits is denied by the employer’s workers’ compensation insurance company (hereafter referred to as “surety”). Many injured employees (hereafter referred to as “claimants”) wonder why the surety would deny their claim because the facts all seem to point to the acceptance to the claim.
As with many things in life, the surety’s decision to deny most compensation claims boils down to one word: money.
Worker’s compensation sureties normally receive only a small contractual discount on the price of a given medical procedure. However, the discounts given by health care providers to a claimant’s personal health insurance are generally far greater than the discounts given to a surety. Knowing this fact, the surety may be tempted to deny the claim initially. Such a strategy could then be completed by the surety later coming to the claimant and offering to settle the claim after the claimant’s private health insurance has paid the medical bills at the contractually discounted price. This issue was addressed by the Idaho Supreme Court in Neel v. Western Construction, 147 Idaho 146, 206 P.3d 852 (2009).
If your claim for medical benefits has been denied consult with an experienced Idaho workers’ compensation lawyer.
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