Do I need to talk to my insurance compnay? 25 Answers as of February 20, 2012

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?

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A. Daniel Woska & Associates, P.C.
A. Daniel Woska & Associates, P.C. | Dan Woska
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.
Answer Applies to: Oklahoma
Replied: 9/1/2011
Andrew T. Velonis, P.C.
Andrew T. Velonis, P.C. | Andrew Velonis
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.
Answer Applies to: New York
Replied: 8/29/2011
E. Ray Critchett, Zaino & Humphrey, LPA
E. Ray Critchett, Zaino & Humphrey, LPA | Ray Critchett
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.
Answer Applies to: Ohio
Replied: 8/27/2011
Paul Whitfield and Associates P.A.
Paul Whitfield and Associates P.A. | Paul L. Whitfield
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)
Answer Applies to: North Carolina
Replied: 8/26/2011
Kelaher Law Offices, P.A.
Kelaher Law Offices, P.A. | James P Kelaher
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.
Answer Applies to: Florida
Replied: 8/26/2011
Bernard Huff, Attorney/Mediator
Bernard Huff, Attorney/Mediator | Bernard Huff
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.
Answer Applies to: Indiana
Replied: 8/26/2011
Law Office of Mark J. Leonardo
Law Office of Mark J. Leonardo | Mark Leonardo
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.
Answer Applies to: California
Replied: 8/26/2011
The Margolis Firm
The Margolis Firm | Charles J. Candiano
You should look to your attorney for advice in this matter. You must remember that these nurses are paid by the employer and do NOT have an obligation to protect your conversations.
Answer Applies to: Illinois
Replied: 8/26/2011
Coulter's Law
Coulter's Law | Coulter K. Richardson
I would tend to agree. They are looking for pre-existing conditions you did not declare on your policy. They can deny your claim for being uncooperative. Demand they provide a copy of your original application and medical screening PRIOR to submitting to the examination.
Answer Applies to: New Jersey
Replied: 8/26/2011
R. D. Kelly Law Firm, P.L.L.C.
R. D. Kelly Law Firm, P.L.L.C. | Robert Kelly
If you have a claim for personal injuries due to somebody else's negligence, you should probably retain an attorney to help you. Then if anybody calls about the incident, you can refer them to your attorney.
Answer Applies to: Washington
Replied: 8/26/2011
    Klisz Law Office, PLLC
    Klisz Law Office, PLLC | Timothy J. Klisz
    Never speak to insurance companies without legal counsel. They have every incentive to deny and destroy your claim.
    Answer Applies to: Michigan
    Replied: 8/26/2011
    LT Pepper Law
    LT Pepper Law | Luke T. Pepper
    It is a responsible to sit down with an attorney to discuss your case before talking to the insurance company.
    Answer Applies to: Pennsylvania
    Replied: 8/26/2011
    Law Office of Jared Altman
    Law Office of Jared Altman | Jared Altman
    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.
    Answer Applies to: New York
    Replied: 8/26/2011
    The Law Firm of Reed & Mansfield
    The Law Firm of Reed & Mansfield | Jonathan C. Reed
    What you have heard is partly true. Insurance companies try very hard to obtain information from you and they try very hard to pay as little as possible. While they are in the information gathering state they make fake sympathy and lead you to believe that they want to pay you fairly. Some insurance adjusters do. Others simply want to pay as little as possible. Even adjusters who "want" to pay you fairly may have a different view of what is fair than your own attorney would. Obviously, if you try to resolve your case without an attorney you have to ultimately talk to the adjuster. In general I believe you will net more for your case if you hire an attorney from the outset or as soon as possible.
    Answer Applies to: Nevada
    Replied: 8/25/2011
    Law Offices of Steven A. Fink
    Law Offices of Steven A. Fink | Steven Alan Fink
    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.
    Answer Applies to: California
    Replied: 8/25/2011
    Lyle B. Masnikoff and Associates
    Lyle B. Masnikoff and Associates | Lyle B. Masnikoff
    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.
    Answer Applies to: Florida
    Replied: 8/25/2011
    Raheen Law Group, P.C.
    Raheen Law Group, P.C. | Wali Raheen
    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.
    Answer Applies to: Virginia
    Replied: 8/25/2011
    Cody and Gonillo, LLP
    Cody and Gonillo, LLP | Christine Gonilla
    That is how many attorneys feel about nurse case managers. You would have to judge your self based on whatever experience you have had.
    Answer Applies to: Connecticut
    Replied: 8/25/2011
    Sargent Law Firm
    Sargent Law Firm | Ryan Sargent
    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.
    Answer Applies to: California
    Replied: 8/25/2011
    Ramunno & Ramunno, P.A.
    Ramunno & Ramunno, P.A. | Lawrence A. Ramunno
    Insurance companies and their employees are not on your side. So you need to be careful and have your attorney handle same.
    Answer Applies to: Delaware
    Replied: 8/25/2011
    Ewusiak & Roberts, P.A.
    Ewusiak & Roberts, P.A. | Christopher J. Roberts
    It really depends on the nature of your claim, and why they need more information. Insurance companies do have a right to conduct an investigation before paying a claim, and if you don't cooperate they could deny the claim. I suggest you talk to a lawyer in your area who can help you determine what to do under your specific circumstances.
    Answer Applies to: Florida
    Replied: 2/20/2012
    The Law Office of Harry E. Hudson, Jr.
    The Law Office of Harry E. Hudson, Jr. | Harry E. Hudson, Jr.
    I suggest that you speak to your attorney. He or she should have a copy, because you provided it, of the policy. The policy may impose requirements respecting some level of cooperation.
    Answer Applies to: California
    Replied: 8/25/2011
    David Hoines Law
    David Hoines Law | David Hoines
    There is some truth to it so be careful what you say she can't help you unless you speak with her.
    Answer Applies to: Florida
    Replied: 8/25/2011
    Bulman Law Associates PLLC Injury Law Firm
    Bulman Law Associates PLLC Injury Law Firm | Thomas Bulman
    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.
    Answer Applies to: Montana
    Replied: 8/25/2011
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