How to Deal With a Workers Comp Claims Adjuster

If you’ve already filed a workers comp claim, chances are you already have a workers’ comp claims adjuster working on your case. But if you think they’re there to help you get your benefits, then you’re absolutely wrong.

Most injured workers want to get their benefits as soon as possible. So if a workers comp adjuster comes knocking at their door claiming to collect information for their claim, they’ll just give them what they want thinking it will help speed up their claim. But that isn’t always the case.

Workers comp adjusters work for the insurance company. Obviously, they will put the interests of that company over your welfare. Their main goal is to reduce your workers’ compensation amount or avoid paying it altogether. That’s why knowing how to effectively deal with them will help you get a favorable outcome.

What Does a Workers Comp Claims Adjuster Do?

In a nutshell, a workers comp adjuster’s job is to weed out compensable from non-compensable claims. And if it’s compensable, how much benefits should be paid. They are trained, very skilled, and knowledgeable about workers’ comp laws.

To do their job, workers comp adjusters have to collect information. This includes carrying out various tasks such as:

  • reviewing your workers’ comp policy
  • confirm that you filed your claim within the time limit
  • gather medical reports related to your injury
  • interview witnesses to the accident
  • put together a team of doctors you can choose from
  • find out your average weekly wage before the incident
  • look out for red flags they can use to deny your claim

Workers comp adjusters are also charged with negotiating settlements. And when a settlement is reached, they authorize the payment of benefits.

Common Workers Comp Adjuster Tricks and Tactics

Since their job is to save their company some money at your expense, workers comp adjusters use various tricks and tactics to achieve that end. Most of them are legal but some may border on intimidation. Familiarizing yourself with these tactics will help you avoid falling prey to them.

Ask You to Sign Documents or Give Statements Immediately After the Accident

Insurance companies know that you’re at your most vulnerable in those few days immediately following the accident. So insurance companies typically send their claims adjusters to get a recorded statement or have you sign documents. Sometimes they do it while you’re still hooked to an IV.

They do this because recorded statements often provide loopholes which they can use to deny your claim.

Discourage You From Hiring an Attorney

Most workers comp adjuster will tell you that hiring an attorney will only prolong your case. Or that after the lawyer takes his cut, you’ll be left with almost nothing. None of this is true.

In fact, those who hire workers comp lawyers are more likely to get their claims approved. This is especially true for workers comp cases that aren’t clearly work-related or need prolonged medical treatments. Also, lawyer fees take only a very small portion of your settlement amount. The rate is usually decided by the court but it can range from 15% to no more than 25%.

A work injury claim form that has not been filled out yet.

Delay the Process

If a workers comp adjuster knows that your finances aren’t looking good, they’ll typically delay the workers’ comp process. Delaying the process also delays your benefits. And if you’re in dire financial straits, you’ll usually just settle for whatever amount they’ll offer.

Don’t Answer Your Calls and Messages

Workers comp adjusters are very busy people. So it’s not uncommon for them to miss your calls or forget to answer your messages. But sometimes, they’ll deliberately ignore your calls and messages hoping that you’ll just give up your claim.

Do’s and Dont’s When Dealing With a Workers Comp Claims Adjuster

Since claims adjusters have a lot of tricks up their sleeve, dealing with them can be a headache. So we’ve compiled these do’s and don’ts when dealing with workers comp claims adjusters:

Report Your Claim ASAP

In most states, you only have 30 days to report work-related accidents to your insurance provider. Failing to file a claim within this time frame will give the adjuster reason to deny your claim.

Return Calls Promptly

Claims adjusters handle hundreds of workers comp cases at any given time. So they ten to make hundreds of calls every single day. If they called you and you don’t answer or return their calls, chances are they won’t be calling you again for the next few days. This could delay your claims process further.

Find Out How Many Caseloads They Have

When a claims adjuster handles too many cases at once, they’re unlikely to bother with minute details. So you have better chances of getting your claims approved. That’s why finding out how many caseloads your adjuster currently has is very important. It can help you gauge the level of scrutiny you’ll receive from them.

Don’t Submit Incomplete Injury Form

One thing that claims adjusters hate the most is an incomplete injury form. It adds up to their work and requires them to make multiple calls. And an irritated workers comp claims adjuster is never good news. So always make sure to completely fill in your workers’ comp injury form before turning it in. Besides, if you leave some portions blank, other people may fill it up and you may not like what they’ll put on it.

Don’t Just Give Out Recorded Statement

As mentioned, it’s not above claims adjusters to force out a recorded statement from you even while you’re still lying in the hospital bed. But know that you are not required to nor should you give out a recorded statement. Remember that the information you reveal in that statement can be used against you.

Don’t Sign a Medical Authorization Form

Medical authorization forms allow claims adjusters access to your medical records. But you don’t have to sign this form and they can’t force you to. Remember that they can use your medical records and any pre-existing condition to deny your claim or reduce your benefits.

Don’t Settle Unless You’ve Consulted an Attorney

One common mistake injured workers make is to settle without consulting an attorney. Remember that insurance companies don’t have your best interest at heart. So the amount they’re offering you is probably much lesser than what you are entitled to.

If you feel like you’re getting the short end of the stick, don’t hesitate to call an experienced lawyer like Victor Malca. He has already helped thousands of injured workers in Florida get the benefits they rightfully deserve. He can help you too. Call us now for a free consultation.

VICTOR MALCA LAW – A TRUSTED NAME IN FLORIDA

Victor Malca Law has over 25 years of litigation experience, we are the most trusted workers’ compensation lawyers in Florida. Our area of expertise is in representing injured workers on compensation benefit cases and disabled individuals claim social security disability benefits.

Our unwavering advocacy for employee rights and privileges are also recognized by our peers. Book a free consultation today.

Judy Ponio is a writer for Victor Malca LawAbout The Author

Judy Ponio is a writer for Victor Malca Law P.A. and enjoys helping people with questions about social security, workers compensation, and other serious matters involving people’s livelihood. She is not an attorney and her writing should not be considered legal advice.

Leave a comment