This came up just the other day, actually, although in this instance it wasn’t a DBA claim. It just seems like a more common question in Defense Base Act cases.

Sometimes you may wonder why the insurance company is or isn’t doing something with your workers’ compensation claim. Maybe you wonder why the claim is denied, or why medical treatment is being denied. I’ve found that most of the time, the answer is “There’s no way to know, plus it probably won’t make any difference in the long run.” This is very unsatisfying, I know, but it’s also true.

My two cents’ worth is that most workers’ compensation claims adjusters have more files than anyone could reasonably expect them to handle, so they are under tremendous pressure all the time. And that can be counterproductive, just like in any other job. So your adjuster may have made a decision out of pressure, because he or she just doesn’t have time to review your file. And it’s easier to say “No” than “Yes.” Plus when is the last time an insurance manager complained at an adjuster about denying a claim?

As to why I don’t think it matters why a decision is made, that’s just me focusing on what we are doing now, and what’s going to happen next. Most of the time, the decisions that have to be made in a case will not change depending on the adjuster’s reasons for taking any given action. So when I’m planning strategy going forward, I do think over what got us where we are, but most of the time it doesn’t really change things much. It’s just a lot of time spent guessing about the thought process of someone who has way more going on than we can possibly know.