I spend all day every day at work dealing with insurance companies. One thing I can tell you for sure is that insurance companies do not exist to pay out benefits. They exist to take in premiums and make money.
Here is an example in two parts out of Florida. A man was severely injured in an explosion at work and suffered second and third-degree burns on much of his body. The insurance company in this case, Travelers, has done a terrible job taking care of this poor man.
I’m not that familiar with Florida law, but apparently Florida can pick who the doctor is, and in this case, the doctor provided very poor information to Travelers.
In Oregon, insurance companies have the ability to limit the choice of doctors to a panel, but the worker has the right to choose a physician within that panel. Quite frankly, in Oregon, most doctors try to avoid workers compensation claims because they are so difficult for the doctor. The doctor gets bombarded by the insurance company, the adjuster, the managed care organization, the claimant’s lawyer if the matter goes into litigation, and a defense lawyer. Doctors are required by their managed care contracts to provide information to the insurance company and to be available to answer questions. Again, most doctors simply won’t put up with that, and as a consequence, in Oregon at least, it can be difficult to find a doctor.
I watched the two videos linked above, and I don’t think Oregon has anything this extreme, but many of my clients experience significant difficulties in getting appropriate care.
