If you have a pending workers’ compensation claim, you most likely have to deal with a workers’ comp claims adjuster. Also known as claim examiners, they are the ones who directly interact with you on behalf of the insurance company. Their primary job is to weed out legitimate claims from fraudulent ones.
But don’t let their seemingly harmless job description fool you. With all the worker’s comp adjuster tricks they employ, trusting them is one of the biggest workers comp mistakes you can make.
At best, you’ll receive fewer benefits than you’re entitled to. At worst, you won’t receive any benefits at all.
WHY YOU NEED TO BE CAREFUL AROUND WORKERS COMP ADJUSTERS
In essence, workers comp adjusters are insurance adjusters who specialize in workers compensation cases. They evaluate a claim, examine the evidence, and decide if it’s eligible for compensation.
But no matter how nice and helpful they may seem, workers comp adjusters aren’t there to help you. In fact, their primary goal is to find ways to avoid paying you benefits.
After all, they are employed by the insurance company. All employees are paid to look out for the company’s best interests. And we all know that insurance companies don’t like paying settlements or compensation.
Because of this, workers comp adjusters will employ all sorts of tricks to get their job done. They may try to befriend you or tell you they are there to help. But, in most cases, they’re just there to collect information they can use against you.
This is why you must be cautious when dealing with a workers comp adjuster. Don’t just do what they want you to do or sign what they tell you to sign unless you’ve talked with your lawyer. Remember that they’re trained and highly skilled in their craft, so they have many tricks up their sleeve.
COMMON WORKERS COMP ADJUSTER TRICKS
To help you avoid falling prey to their ploy, here are some common workers comp adjuster tricks and how to avoid them.
1. ASK YOU TO SIGN A STATEMENT IMMEDIATELY AFTER THE ACCIDENT.
An injured worker is at their most vulnerable immediately after the accident. Aside from dealing with the trauma, many still suffer from the effects of medications. So, if you tell them to sign something with the promise that it will speed up their claim, they’ll sign it.
This is one of the most common tricks workers comp adjusters use, and it serves them a lot of purpose.
For one, they can use the information in your statement to prove that your injury isn’t work-related. Or they can use it to assess your financial situation and how likely you are to accept a lowball offer.
How to deal with it:
Know that you are not required to sign nor release any statement. They can’t force you to sign or release one, either. So, if they ask for your statement right after the accident, tell them you’ll talk to your lawyer first. Don’t say anything unless you’ve spoken with your lawyer.
2. OFFER A SETTLEMENT RIGHT AWAY.
Sometimes, a workers comp adjuster will offer you a settlement immediately. While it might be tempting just to accept it, that might not be the wisest course of action.
Insurance companies don’t offer a settlement immediately unless it’s to their advantage. More than likely, the settlement they’re offering is way less than what you’re entitled to. So, if you accept it now, you’ll miss out on the benefits you deserve.
Also, if your injury or disability worsens, you won’t be able to negotiate a higher settlement.
How to deal with it:
Don’t accept the settlement right away. Discuss it with your lawyer first to help you negotiate a higher amount.
3. TELL YOU THAT HIRING A LAWYER IS IMPRACTICAL.
Injured workers aren’t legally required to hire a workers compensation lawyer. However, doing so can significantly increase their chances of getting approved.
This is why a workers comp adjuster often says hiring a lawyer is impractical. They’ll either tell you that it will cost you a lot of money or that having a lawyer will only slow down your case.
All these are lies meant to discourage you from getting legal help.
For one, lawyer fees are capped by law. Meaning they can’t just charge you how much they want. Also, a lawyer will not slow down your case. On the contrary, they can help your claim get approved much faster.
How to deal with it:
Do the opposite if they tell you not to hire a workers comp lawyer. Hire an experienced workers comp lawyer like Victor Malca. He has already helped lots of injured workers in Florida. He can help you get the benefits you deserve, too.
4. ASK YOU TO SIGN MEDICAL AUTHORIZATION FORMS
This is another worker’s comp adjuster trick you must be wary about.
As their name suggests, medical authorization forms allow someone to look into your medical records. They can examine your medical history to see if you have any preexisting illnesses. They’ll then use this to argue that your injury isn’t work-related but a result of your pre-existing condition.
How to deal with it:
You are not required to sign a medical authorization form. So, if they ask or coerce you into signing one, call your lawyer immediately. Tell them you’re not signing anything unless your lawyer gives the green light.
5. DELAY YOUR WORKERS COMP BENEFIT CHECK.
If they see that you are struggling financially, one workers’ comp adjuster trick they’ll typically use is delaying your workers’ comp payment.
Making ends meet can be difficult if you can’t go to work because of your injury. Workers comp adjusters are banking on that to force you to accept a much lower settlement amount.
How to deal with it:
The law sets certain days for insurance carriers to decide on a claim and release the payment. Failure to do so can get them penalized.
Ask your insurance carrier why your payment is delayed. If they don’t release it on the date set by law, talk to your lawyer about the best course of action.
6. MISS YOUR CALLS ON PURPOSE.
While some workers comp adjusters are truly busy, some will purposely ignore your calls. They do this hoping you’ll eventually get tired and give up on your claim.
How to deal with it:
If you can’t get hold of your workers’ comp adjuster on the phone, you can visit them directly at their office.
7. SEND A WORKERS COMP INVESTIGATOR TO FOLLOW YOU.
Sometimes, insurance companies hire a private investigator to determine if your disability claim is valid. These workers comp investigators follow you around, snapping pictures and taking videos. They may also interview your friends, neighbors, and family members.
If they can get evidence that you aren’t telling the whole truth about your disability, they can use it to deny your claim.
How to deal with it:
If you have an ongoing workers comp case, always assume someone is watching your every move. Don’t do things that you think could compromise your claim.
8. DOWNPLAYING THE SEVERITY OF YOUR INJURY
Some adjusters may try to cut the seriousness of your injury to offer a lower settlement amount. They may argue that your injury is not as severe as you claim or unrelated to your work.
How to deal with it
Gather all necessary medical documentation and evidence. All of which must support the severity and work-relatedness of your injury. Consult with your doctor and attorney to strengthen your case.
9. REQUESTING A RECORDING OF YOUR STATEMENT
Adjusters may ask to record your statement to use it against you later in the claims process. They might try to manipulate your words or take them out of context to cast doubt on the legitimacy of your claim.
How to deal with it:
Politely decline their request to record your statement. Instead, provide a written account of the incident. You can also consult with your attorney before giving any official statements.
10. PRESSURING YOU TO RETURN TO WORK PREMATURELY
Some adjusters may try to rush your return to work, even if you are not fully recovered. They may claim that you are ready or that delaying your return will negatively impact your claim.
How to deal with it:
Follow your doctor’s recommendations, and do not return to work until fully healed. Communicate with your healthcare provider. Document any lingering symptoms or concerns that may hinder your ability to perform your job.
11. QUESTIONING THE NECESSITY OF YOUR MEDICAL TREATMENT
Adjusters may dispute the necessity of specific medical treatments or procedures your healthcare provider recommends. They may argue that the treatment is excessive or unrelated to your work injury.
How to deal with it:
Consult with a specialist or second healthcare provider. They can provide an unbiased assessment of your treatment needs. Keep detailed records of all medical appointments. Keep your prescriptions and recommended treatments to support the validity of your claim.
WHAT NOT TO SAY TO A WORKERS COMP ADJUSTER
To further avoid falling prey to a workers comp adjuster’s tricks and tactics, here are some things you absolutely must not say to them:
- Information about your or your family’s financial situation. They can use this to lowball you or delay the claims process so you’ll agree to a much lower settlement.
- Consent for the phone call to be recorded. These recordings will most definitely not be used to speed up your claim. Instead, they’ll use it to find loopholes or contradicting details in your claim.
- Exaggerations about your condition. They’ll eventually see through it anyway, which is bad for your claim.
Though all of the above can help, sometimes it can be hard to tell if your workers’ comp adjuster is just playing tricks on you. So, don’t hesitate to call your lawyer if you think this is the case.
VICTOR MALCA – Florida Workers Compensation & Social Security Disability Attorney
Victor Malca P.A. has over 27 years of litigation experience in Workers Compensation and Social Security Disability lawsuits. His experience and continued success when fighting for his clients puts him among the most trusted workers’ compensation attorney’s in Florida. He specializes in representing injured workers on compensation benefit cases and disabled individuals claiming lost social security disability benefits.
Book a free consultation today. Our unwavering advocacy for employee rights and privileges are recognized by our past clients across South Florida.
About The Author
Judy Ponio is a writer and editor for the Victor Malca Law P.A. website and blog. She enjoys helping people in need with questions about social security disability and workers compensation law. She has a passion for helping those in need and the elderly with accurate legal information that can make a positive difference in their lives.