How to Tell When the Workers’ Compensation System is Breaking the Rules Instead of Just Being Slow

Corey R. PollardWorkers' compensation & disability attorney · Former insurance defense · Best Lawyers in America®

I built Corey Pollard Law to fight for injured workers in Virginia. You get hurt on the job, and you suddenly find yourself trapped in a cold system. You wait weeks for an MRI approval or a check for your accrued benefits. The bills stack up. You start wondering if the insurance adjuster is overwhelmed with files or if they are actively trying to starve you out. The distinction matters. You need to know the difference between a standard administrative delay and an illegal bad faith denial so you can protect your financial and medical stability.

Third-Party Administrators Use Administrative Delays to Protect Their Capital

Adjusters prioritize their internal metrics over your immediate medical needs. I know exactly how these corporations train their representatives because I began my career in insurance defense. A standard administrative delay happens when the adjuster waits on paperwork. They need the clinical notes from your doctor. They require a signature from a supervisor. Bureaucrats move slowly by design. Your treatment stalls while the file slowly moves from one desk to another.

Third-Party Administrators rely on this friction for their strategy. They want you to get frustrated. They win when you accept a lowball settlement just to get some money in your pocket today.

Four Warning Signs That Your Claim Delay Is Actually a Bad Faith Denial

Repeated Requests, Biased Examinations, Radio Silence, and Ignored Orders.

You can identify illegal stalling tactics by watching how the adjuster handles your specific medical requests. Adjusters leave a paper trail when they cross the line from incompetence to malice. Look for these specific behaviors:

• The adjuster asks for the same documentation three different times after you already sent it.
• The insurer schedules an Independent Medical Examination weeks away with a doctor known for ruling against injured workers.
• The claims representative refuses to return phone calls or emails for weeks at a time.
• The insurance company denies a specific treatment your primary doctor explicitly ordered, citing a lack of information they already possess.

If you see these patterns, the insurer is actively working to devalue your claim, which directly threatens your ability to secure your Maximum Medical Improvement (MMI).

Insurance Companies Commit Bad Faith When They Ignore Clear Medical Evidence

The insurance company crosses a legal line when they possess all required medical proof but refuse to approve your treatment anyway. Insurance adjusters commit bad faith intentionally. You provide the MRI results. Your doctor clearly states the injury happened at work. The adjuster still denies the claim. They know they owe you the money. They simply refuse to pay it.

I see this constantly with major TPAs like Sedgwick and Gallagher Bassett. They break the rules because they calculate that paying a penalty later is cheaper than paying your accrued benefits today. When an insurer ignores the facts to protect their profit margin, you lose access to the care you desperately need.

We Litigate Bad Faith Denials to Force the System to Honor Your Claim

We take the insurance companies to the Virginia Workers’ Compensation Commission to expose their illegal tactics. You cannot negotiate with a cold system. You have to force it to act. When I see an adjuster sitting on clear medical evidence to delay your Permanent Partial Disability (PPD) rating, I file a claim for a hearing. We put the facts in front of a judge.

My background in insurance defense gives me the blueprint to dismantle their excuses. We recovered over $100 million for injured workers by refusing to accept strategic delays as standard procedure. You have the right to timely medical care and financial support. I hold the insurance companies accountable so you can focus on rebuilding your life and protecting your family.