Do I need to talk to my insurance compnay?

Question

I have heard that registered nurses working for insurance companies who contact you are only looking to get more information on your case so that the insurance company can deny any claims related to it.  Is this true?  Should I not speak to these people?

New User · Answer

It is difficult to answer your question without more detail about the case.

Marty Judnich · Answer

It is typically best to speak with an attorney before giving a statement to an insurance company to protect your rights.

Eugene Critchett · Answer

Generally, I caution my clients about giving recorded statements and/or providing information that is not pertinent to the claims being asserted.  I cannot advise you to give a statement or not to as there is not enough information but keep in mind that insurance companies are businesses and businesses exist to make money.

A. Woska · Answer

While perhaps shocking to the unaware, the insurance company model is to pay the least amount of money possible on any claim. Nurses often help spot problems in records which allow the defense lawyers to use that information to deny claims.  In the current business climate you will find this situation repeated over and over. The insurers are often there to help initially but the amount o be paid to you is determined by people  living in other parts of the world using regression analysis and dynamic reduction of the monies you will be paid by your insurer.

Andrew Velonis · Answer

Usually, what the insurance company is trying to do is to get the best medical results for you that they can as a result of the dollars they spend.  If the treatment is effective, then the benefit to you is that you have gotten effective treatment, and the benefit to them is that once you are done with treatment, there are no more medical expenses for them to pay.  They are entitled to copies of your records, so they already know what the providers are saying about you.

Paul Whitfield · Answer

Of course, but maybe overstated a bit. The nurses that serve as casemanagers are supposed to get you back on the job as soon as possible (and save the company money). If they find out things about you that may compromise your case then of course that could be to your disadvantage. Remember they work for the company, not you.  But you do need to cooperate with them. Just be careful. If you are claiming a back injury don't hoist your motor out of your car in the backyard where a camera might record your physical situation (saw that happen more than once)

James Kelaher · Answer

While that might possibly be true in this particular instance, the bottom line is that you have both a contractual and statutory duty to cooperate with your own insurance company. Don't be surprised if they want you to be examined by a physician of their own choosing, as before they can deny your benefits and cut you off from treating with the physician of your choice, they have to have an opinion from a physician licensed under the same chapter of Florida statutes saying that you don't need any more treatment or therapy. Until they get that opinion, they can't cut you off....unless.... you refuse to cooperate with them, at which time they can cut you off for failure to cooperate.

Bernard Huff · Answer

If there is a pending claim in which you are involved, you should contact and consult with an accident attorney for legal advice and/or representation.

Mark Leonardo · Answer

I have never heard of a nurse contacting the companys own insured to get information.  You need to look at your policy.  It likely has a cooperation provision but it might not require you to speak to a health care provider.

Jared Altman · Answer

It may be one if the reasons they call, but not the only reason. The insurance company also wants to estimate how much your total treatment will eventually cost.

Timothy Klisz · Answer

Never speak to insurance companies without legal counsel. They have every incentive to deny and destroy your claim.

Steven Fink · Answer

Your insurance company has a duty to cooperate clause in your policy. This means if you do not honestly answer questions they can try to deny coverage.  Nurses primarily want to know about your health so they can evaluate the medical issues in the case and perhaps recommend treatment to help you recover.  The fact that some information may hurt your claim is part of the process.  You have to speak to them.  You do not have to answer all questions they ask.

Syed Raheen · Answer

Insurance companies look out for themselves.  You don't provide enough facts to determine the nature and cause of your injury and the reason for talking with insurance company.  If you have been injured due to someone else's fault and it's their insurance company trying to contact you, you need to speak with a personal injury attorney to evaluate your case.

Lyle Masnikoff · Answer

I would avoid speaking to them other than to just schedule an appointment.  I would recommend hiring an attorney so you don't have to speak to them.

Lawrence Ramunno · Answer

Insurance companies and their employees are not on your side. So you need to be careful and have your attorney handle same.

Ryan Sargent · Answer

It depends on what insurance company you are referring to and the circumstances of your case.  If you were involved in an auto accident and you are referring to your auto insurance, I would not speak with them.

Thomas Bulman · Answer

You must generally cooperate with them, but you can ask to meet with your doctor alone and prohibit the nurse case manager from talking directly with your doctor.  Ask her to do all communication by mail, with a copy to you of all correspondence.  Let the doctor's office know your wishes too.

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Do I need to talk to my insurance compnay?

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