How do I get the insurance company to believe I a really in pain?

Question

I have a worker's comp injury where I fell down cement stairs, out cold, awoke in ambulance. Have 3 disc bulges and whip lash type injury. I now suffer with extreme headaches. I have FCE Tues and insurance doctor said "they will know if you are cheating" I am not exaggerating at all. My question is do they assume all inured workers are fraudulant? How do you get past doctor's who obviously has formed an opinion of me that isn't accurate. I am a very honest person caught in a bad situation. Any insurance adjusters who have insight let me know. I am starting to take this personally and not to sound juvanile...my feelings are hurt.

Believe I AM really in pain

I have another doctor, but it seems like the insurance company will only approve what their doctor recommends which...is different from my doctor, I do have an attorney but I hate going that route.

FYI I used layman's terms so anyone could answer not just those in the medical field

Answer 1

It might not be right but many adjusters have a pre-conceived idea that most injuries are faked to some degree. Doesn't matter could be work/comp, slip and fall, auto accident you name it. Even if there is a legit injury, too many people try to make it out worse than it is because of the allure of the "easy money" from an injury claim. And yes in some cases a Dr. can determine if a person is faking their claims of injury. However, if your injury is legit it won't effect you.

Pain is a very hard thing to verify. It doesn't show up on any diagnostics although the tests can show things that should/could/might cause pain.

If you really are injured the best course for you is to have good med records from your doctor and be truthful with the insurance Dr. in both your physical and verbal responses. The best advice I can give is to be honest, calm, respectful and non-confrontational.

Good Luck

Answer 2

Check your state laws - most states allow you to get a second opinion, or another doctor. On the other hand, they ALSO allow the insurance company to contest a claim, with an exam by THEIR physician.

They'll do testing, and look at your prior medical history. Were the three disc bulges prior conditions? If so, they aren't covered. Have you ever suffered from headaches in the past? If so, these headaches probably aren't related.

Insurance companies see hundreds of thousands of claims - and they have a pretty good idea what "usually" happens when someone falls down the stairs and knocks themselves out.

Of course, not ALL workers comp claims are fraudulent! But there is a really high percentage of fraudulent claims in workers comp - more than ANY other line of insurance. So especially when test results show nothing new wrong - or doctor's opinions differ from the injured employee's opinions - they assume something fishy is going on.

Expect to have ALL your prior medical records examined really, really closely.

Answer 3

I don't believe you are a nurse,
The terms you use, "out cold" "whip lash" are layman's terms. Anyone with a bit of medical training would say, "unconscious, "' whiplash".

As a former health insurance adjustor, this is a dead giveaway.

Answer 4

Only by medical evidence, and if your not happy with the first diagnosis, ask for another opinion, but if that says the same, you have got no chance

Answer 5

Is there any possibility of getting a second opinion from a neutral party?

Answer 6

That's how I.D.'s are, they cheat you. I'd go to another doc, get a note, maybe go to a lawyer and find out your rights.