Aegis RMS’ Post

Name: How to convince insurers to reject claims | Aegis RMS posted on the topic | LinkedIn
Uploaded: 2024-06-26T15:06:48.214Z
Duration: 1 min 42 s
Channel: Aegis RMS
Description: When a claim arises and there is a lack of evidence connecting the injury to work, it is possible to convince an insurer to reject a claim awaiting further evidence. From a recent workshop, Aegis RMS Director Simon Booth explains this potential situation further. #managingclaims #workerscompensation #aegisrms

Aegis RMS

1,067 followers

5mo

When a claim arises and there is a lack of evidence connecting the injury to work, it is possible to convince an insurer to reject a claim awaiting further evidence. From a recent workshop, Aegis RMS Director Simon Booth explains this potential situation further. #managingclaims #workerscompensation #aegisrms

Transcript

Now there might be times where you can convince the insurer to reject a claim awaiting further evidence. So we had one recently where there was no, there was absolutely no evidence to to show that what the person was saying was their injury was caused by work. Right. There was there was nothing. It was and it was, there's other situations where, you know, things like heart attacks, strokes, these sort of things actually have to are excluded under the act unless you can tie them back in. Now the insurer will say, oh, but there's it's on the certificate. So yeah, but you need medical evidence, you need something to confirm this, right. So we came in that situation and say, well, reject it. And if you can get as clinical notes from, you know, two years ago and they said they arranged to show they went to the doctor back then because we make these arguments saying, well, they never had time. But they might have gone to the doctor and physio every week for six months to be able to stay at. And if they show a sediment, I'll happily accept the client. So if you can prove that stress led to it. Yes, alright, we've had an aneurysm claim that was initially rejected but overturned it. Right. So these things are, you know, you have to draw that causal link, right. But sitting there and saying to people, look, you know, as much as we can need to show him to say it wasn't working at it. You haven't even shown us shown us evidence to show that was an injury. Or there was an incapacity. Now you're talking about something happen a year, two years ago. Surely they saw a doctor. Ohh, no, they didn't. They didn't. OK, well, if they didn't say doctor, how can we say that this, this incident caused an injury? No. If we haven't got the clinical notes in that situation, but they're trying to get them, they can reject the claim until evidence comes in to confirm.

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