How Your Company’s Insurance Claims Process Affects You After a Workplace Accident

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November 3, 2020

by Timothy J. Young, New Orleans Maritime Attorney

Similar to how people buy car insurance in case of car accidents, maritime companies buy insurance policies to cover workplace accidents and payout the injury settlements from that policy. Because your company is primarily interested in self-preservation and protecting itself, their strategy for handling a workplace injury is to minimize their role in the accident and downplay the extent of the injury. 

The following video discusses the claims process  in more depth, the rationale behind some of the company’s decisions, and how this can impact your health and future.

Do Maritime Companies Have Insurance to Cover Accidents?

0:11 Yes. I’m Maritime Attorney Tim Young. A lot of our clients come into our office, and we end up representing them, and they tell us again and again, especially at the beginning of the claim, that they’re worried about the company. They’ve enjoyed working with the company.

0:25 What we explain to them right away is maritime companies will buy insurance. They pay premiums. They pay money to be covered for their accidents that happen to workers just like you. There is a policy of insurance out there. The reason it was purchased was to pay for damages suffered to employees while they’re working. That is the money that an injured maritime worker typically is going after to be compensated. Those are the people we deal with when we get settlements or when we go to court on behalf of our clients.

This is not money out of the company’s pocket typically.

0:58 Typically, it is already known by the company that accidents will happen. This is why they have accident reports. This is why typically they may have even a case manager who takes a claim and starts to handle it for the company.

1:15 All of that should tell you that your company expects, unfortunately, they expect some workers to be injured, and they’re smart enough, and frankly, nice enough, to get insurance, which will compensate the injured workers.

1:28 Some of our clients come in, and they’ll actually say, “I know Johnny in the office who runs the office. He’s going to take care of me in this case,” but what’s interesting is when the case is getting settled, it is not anyone from the company themselves that is typically involved in deciding how much to pay and in evaluating our client’s case.

1:49 It is typically the insurance company, and they will send a representative, and that’s who we’re usually dealing with. A lot of our clients struggle with this because they really have a high level of respect for their own company. At the end of the day, it’s an insurance adjuster making the decision on how much to pay on an injured maritime worker case.

2:09 One easy way to think of the claims process is, it’s a tiny, tiny way, it’s a little bit similar to a car accident. People right away understand that when they’re in a car accident, they typically submit the claim to the other car’s insurance company. It may be a wonderful, nice lady from down the street who was not paying attention, ran a stop sign, injures yourself a little bit, maybe damages your car. Typically, people understand that that lady has insurance, and she may be a wonderful person, but the nature of it is, you have some damage to your car, maybe physically, and the reason she has insurance is for that very purpose. You then make a claim. You talk to her insurance company, and you deal with them.

2:51 What’s interesting is our clients, I guess because of the nature of maybe a lot of them have worked at these companies for long times, which is wonderful, a lot of them feel very close to the company, they sometimes don’t see it that way. I can guarantee you what happens with the claims process after a maritime injury is just like a car accident, just on a much larger scale. Your company will have the accident report. They’ll have the claim. They will open up a file on it. They will then contact their insurance company, and they will basically turn it over to their insurance company.

3:26 One thought I want you to think about is when we go with our clients to settlement conferences or meetings where we’re trying to resolve the case, do you know who attends those cases, those meetings? Do you know who sits at those meetings with the company lawyer? It is an insurance company representative who sits and judges our client’s case and tells us how much that insurance company is willing to pay for our client’s case. It is never the people that worked on the boat with you. It’s never your supervisor or his supervisor. It is a person heavily engaged in the claim process in the insurance company itself. Think about that when you start to think about the claims process behind your case.

How Your Company Works Behind the Scenes to Protect Itself

4:12 I want to try to set this up for you. I want to try to explain it to you so you really get a feeling of how some companies are really organized, focused machines after you get injured.

4:26 One of the first things they’re going to want to do is look into defending why your accident happened. A lot of our clients come in, and they just say, “Well, it’s basic. There’s one set of facts. This is exactly what happened. Nobody can really change that.”

They Shift the Blame to You through a Carefully Crafted Paper Trail

4:40 Well, your company’s claims process spends a lot of time trying to frame it, trying to tweak it, trying to make it look better for them. They will usually go out and write up reports after your accident that maybe blame you more than you should be taking responsibility for it. Your company is going to write up reports afterward that do not blame themselves. These are usually done in the form of root cause analysis reports. We do, from time to time, see some that blame the company, but very rarely do you actually get a good company-generated report that talks about what truly happened and what truly caused the accident.

Their Goal is to Minimize the Amount of Compensation They Have to Pay

5:19 On a more practical level, what’s going on with the claims process behind the scenes is the company wants to control the amount of damage that you have suffered. In your case, there are two important things. One is why did you get hurt? What actually happened to you? This is where the company will be taking recorded statements. They’ll be trying to defend themselves. The second is how badly are you hurt. This is where they control your medicals.

Your Company is Defending Your Injury Case Before You Even Hire an Attorney

5:42 This all goes on regardless of whether you have an attorney or not. I think that’s a key point. Let me say that again. The minute you get injured, this starts going on behind the scenes. You can talk to five attorneys, and it’s not going to make a difference. Your company will continue to do this. You can be unrepresented, you can talk to your company every day, you can tell them you want to come back to work. They will handle your claim this way regardless of whether you feel like you’re being a good guy and you feel like you’re really staying with the company.

6:14 What happens first is they want to know why did you get hurt. They try to argue, they try to build a case that they didn’t do anything wrong.

They Want You to Appear Less Hurt Than You Really Are

6:22 On the more important side, and this is where you will notice probably some stuff I say right now, what they’re doing on the damage side, again, remember, the big question is how badly hurt are you. Their claims process will very often take control of your medical situation. Some of the people that come into visit us who become our clients, what they see is the company calling them, setting up doctor appointments. They may see a case manager, a nurse case manager going to the doctor appointment with them. Often, they think that’s wonderful, and often, they think, “This company really cares,” and, “This company is really going out of their way. They’re really making an effort to take care of me.”

7:04 Unfortunately, what’s happening a lot of times is the company wants to control the medicals, and so they’re picking doctors for you. The case manager, the nurse case manager, and sometimes, they’re wonderful people. They’re genuinely nice.

Fewer Tests Mean Less Evidence that You are Seriously Hurt

7:18 What they’re doing though is they’re wanting to steer your medicals and they’re wanting to get fewer tests done typically, and they typically want to get you back out as quick as you can because if you’re back out at work in a month, you couldn’t have been injured that badly.

Your Injury is a Potential Threat They Have to Guard Against

7:33 The other thing going on behind the scenes with the claims process is, and this is another critical thing that when we explain this to our clients, people who hire us, kind of a light bulb goes off. The claims process is such that most companies will have an accident report done. It goes to the office. From there, it will go to usually an insurance adjuster. Your company, a lot of times, is out of the loop. The people you worked with on the tug boat or the barge or the oil rig, the rig manager, the port captain, those are not people generally making decisions at this point. What’s happening behind the scenes is your claim has now been escalated, it’s now been put into a different bucket for the company where the company now sees it as, honestly, a liability.

They see it as a threat, and they’re going to treat the threat like anybody else does. They try to protect themselves against the threat.

After an Injury, You are Seen as a Liability, Not a Hard-Working Employee

8:30 When you get injured, I guess the short way to say it is, unfortunately, they’re not valuing you as the person, they’re not judging you as the person that got hurt. What they’re typically seeing as part of the claims process is it has now become a threat, and it represents either a smaller dollar amount or it represents potentially a very large dollar amount cost to them. They see it in those terms. They don’t see it as John from Mississippi who worked for us for five years or Bill from Texas or Issac from Louisiana. They see it as, “This will cost us, and we want it to cost us a little bit rather than a lot.”

Contact Us if You Have Any Questions

9:11 Let me know if you have any more questions about their claims process. We really have seen the inner workings. We’ve taken depositions of their claims managers. We’ve seen the documents internally. We’ve seen emails internally where they may be saying one thing to the employee, but around the office and with their insurance company, they’re emailing different information. It’s important that you understand it’s not always as it appears after you get injured.

Visit us at JonesActLaw.com or call our office at 504-680-4100.

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