Why Gallagher Bassett and Other TPAs Deny Worker’s Compensation Claims

Why Gallagher Bassett and Other TPAs Deny Worker’s Compensation Claims

Has Gallagher Bassett Denied Your Workers Comp Claim? You’re Not Alone

Many people do not know when their employer is self-insured for worker’s compensation benefits. Under Wisconsin’s worker’s compensation law, large employers who meet certain asset requirements can be self-insured for some or all of their worker’s comp liability. Some of those self-insured employers adjust injury claims themselves, but most of them hire third party administrators (TPAs) to do their work for them. Prominent TPAs include Gallagher Bassett, Sedgwick, and Broadspire. Companies that issue insurance policies – such as Zurich and Sentry – also do TPA work for self-insured employers.

TPAs Can Make Worker’s Compensation Claims Difficult

Dealing with worker’s compensation TPAs like Gallagher Bassett can be frustrating. It sometimes seems like they have a revolving door of claims adjusters, or seem to never get back to you, or seem to treat you with disregard. This is often not an accident. TPAs operate on very thin profit margins because they are simply administering a self-insured employer’s money and get paid on a transactional basis, as opposed to issuing an insurance policy on which they can make a more solid profit. Most importantly, though, they are often getting instructions from the employer on what to do with its money. Employers like to make money and keep it, and if an employer is self-insured, they have a very effective way of keeping their money by instructing the TPAs to deny claims or make the worker’s compensation claims experience unpleasant for an injured worker.

Understanding How TPAs View Injured Workers

Remember when you are dealing with Gallagher Bassett, Sedgwick, or Broadspire, you are not dealing with an insurance company. You are dealing with people who are administering your employer’s own money. And in worker’s compensation, you are not looked at as the premium payer or policyholder, you are looked at as “the loss.” So worker’s compensation claims adjusters in these in-house scenarios have a strong incentive to deny claims when they can.

Wisconsin Workers Can Fight Unfair Worker’s Compensation Denials

If you have a legitimate claim that has been denied or improperly adjusted by a TPA such as Gallagher Bassett, give us a call. We at Hawks Quindel have extensive experience in dealing with these companies, and dealing with denied or improperly adjusted worker’s comp claims. Our team of dedicated worker’s comp lawyers can advise you of your rights, appeal denied claims, and get the maximum compensation you are entitled to under Wisconsin law.