A lot of injured workers end up feeling like the whole system is working against them. You’re stuck trying to figure out confusing rules while insurance companies — who know the system inside and out — hold all the cards. So, is workers' comp officially "rigged" against workers? Let's break down exactly how the system tilts against you — and what you can do to protect yourself.
Believe it or not, workers' comp — at least in New York — is actually designed to favor injured workers. One of the biggest protections you have is the presumption rule. If you get hurt while doing your job, the law assumes your injury is work-related. You’re not stuck proving it — the law gives you the benefit of the doubt right out of the gate.
For example, if you’re at your desk and a computer monitor falls on you, that's obviously work-related. But even if you pass out while working, it’s still presumed to be connected to your job unless the insurance company can prove otherwise. Same thing if you’re driving to meet a client after hours and get into a crash — if you’re working, you’re covered.
The whole idea is to make it easier for injured workers to get benefits without getting stuck in endless battles just trying to prove they were doing their job. It’s meant to give you a fighting chance when you're already dealing with enough.
When you’re missing paychecks, fighting for medical care, and drowning in paperwork, it’s easy to feel like the whole system is stacked against you. Some people even start thinking judges must be siding with insurance companies or something shady is going on.
But most of the time, that’s not it. Judges aren’t taking bribes, and insurance companies (usually) aren’t breaking the law. They’re just pushing every legal limit they can — and they know exactly how to do it.
Here’s the truth: the minute you file a claim, you’re thrown into a system you barely know — and the insurance companies know it inside and out. This is their game. They know every deadline, every loophole, every trick — because it's literally their job. You, on the other hand, are trying to heal and figure things out at the same time.
And it’s not just one person you’re up against. They’ve got full teams — lawyers, adjusters, nurse case managers, medical consultants — all working to protect their money by paying you as little as possible. They’re pros at it, and if you’re not ready, it’s easy to get steamrolled.
It’s not just about who has more resources — it’s about priorities. You’re focused on getting better and staying afloat. They’re focused on cutting costs. That’s how they stay wildly profitable.
Workers' comp checks are supposed to help you stay afloat while you heal, but insurance companies love to drag it out as much as they legally can. Even though benefits are technically awarded weekly, most companies pay every two weeks — not because they have to, just because they can. And if something pops up — like a hearing or a paperwork issue — they’ll often stretch it even further, leaving you stressing over how you’re going to pay your bills.
If your doctor says you need surgery, an MRI, or any special treatment, the insurance company usually gets 30 days to approve or deny it. And guess what? They almost always wait until day 30 to give you an answer. If they deny it, now you’re stuck waiting another 30 days just to appeal. Meanwhile, you’re still hurting and stuck in limbo, unable to move forward with getting better.
When there’s any question about your injury or treatment, the insurance company will send you to an IME — but don’t let the word "independent" fool you. These doctors are often paid by the insurance companies and have a funny way of downplaying how bad your injuries really are. Their reports can slow down or cut off your benefits, and fighting back takes time, effort, and energy — all while you’re trying to heal.
Just because your claim gets approved doesn’t mean you’re in the clear. Months down the road, the insurance company can come back and say, “Hold on, we’re not so sure about this anymore.” They can start picking apart your case — questioning your injury, your treatment, even whether you should be getting benefits at all — and suddenly you’re right back in the middle of a fight you thought was over.
After wearing you down with delays and red tape, the insurance company might swoop in with a settlement offer — and it’s almost always way less than what your case is really worth. When you’re strapped for cash and just trying to survive, $10,000 or $15,000 can sound like a lifeline, even if it’s nowhere close to what you actually deserve.
Sometimes insurance companies will actually hire private investigators to watch you. And just mentioning the word “surveillance” in court can make a judge start looking at you sideways — even if they don’t have anything real on you. It’s a cheap trick to plant doubt and put you under a microscope, whether you’ve done anything wrong or not.
Even if you win your case, the insurance company can file an appeal — and then your case can just sit in limbo for months, sometimes even a year or more. While you’re stuck waiting (and probably not getting paid), they’re betting the money pressure will get to you and push you to settle for way less than you deserve.
Another way they can drag your case out is if you’re found partially disabled, they can make you start looking for work — even if you’re still pretty banged up. It’s just another way they shift the burden onto you and make it harder to keep getting the benefits you need.
If you’ve got questions about your case or just want to know what your options are, give me a call. No pressure, no obligations — just a real conversation about what’s going on and how we might be able to help. You can reach me, Rex Zachofsky, directly at 212-406-8989.
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