You need to watch out for workers’ comp adjuster tricks while pursuing a workers’ compensation claim. Workers’ compensation adjusters use tricks, like asking for a recorded statement and scheduling independent medical exams, to lock you out of or reduce the benefits. So, when one approaches you, don’t answer personal questions or sign anything without a lawyer’s intervention.
Workers’ compensation claim adjusters help analyze and validate claims regarding work-related injuries or illnesses. They ensure the claims are eligible and accurate for compensation. They also liaise with a company’s departments to collect data that can help in the claims process. Their liaison with external and internal parties also helps them determine the fair compensation amount and negotiate claims with injured workers.
Depending on the company, workers’ comp adjusters may manage occupational safety and health logs and ensure the company has awareness programs for risk management and operational safety guidelines. This way, they can help prevent work-related injuries from occurring.
In the context of an ongoing workers’ compensation claim, adjusters handle the litigation on behalf of the employer. They also file state-mandated forms while trying to reach proper settlements with injured workers. As such, they usually work in favor of the employer, not the employees.
If the claims become complex, the insurance adjuster may intervene with approaches, such as reserving practices, litigation management, medical management, and vocational rehabilitation. They also oversee all vocational and medical rehabilitation services on the employer’s behalf.
Eligible workers injured at the workplace can count on adjusters for recommendations on vocational and medical rehabilitation services. Also, employers can count on them to prepare claims for hearings and communicate with attorneys or medical providers.
Depending on the phase of the workers’ compensation claims process, adjusters may get authorizations for proper testing, like MRI studies, at the employer’s request. They may also oversee the release of various medical documents for a company to comply with HIPAA rules and compile workers’ records, such as time sheets and payroll data.
Like other insurance adjusters, workers’ compensation claims adjusters do not have your best interests in mind. They may try to fake sympathy or empathy to weaken or damage your claim entirely. Since you need to be a step ahead of them, here’s everything you should know about their antics:
If a workers’ compensation adjuster asks you to give a recorded statement, view it as a red flag. Adjusters use it as an opportunity to misinterpret your words. They may persuade you to make a statement through misleading questions, comments, or suggestions.
If you fall for this trick, you may say things you believe can benefit your case, but have the opposite effect. Adjusters take things out of context to downplay claimants’ injuries or illnesses.
They also try to scare injured workers by telling them they risk losing compensation if they don’t talk. If one uses this trick on you, remember there is no legal mandate to give the recorded statement.
Avoid speaking with the adjuster when upset, confused, or under the influence of pain medication. Let your lawyer handle the communications on your behalf if you are uncomfortable talking.
You should only share a copy of your medical diagnosis and treatment report with the adjuster. The medical records should capture the treatment you sought for a work-related injury or illness. Do not agree to share detailed medical documentation.
The adjuster may request you to sign a blanket medical release form, which fails to specify the healthcare providers and dates for the documents you are comfortable releasing. Decline any request to sign the form, since your medical history before the work-related injury or illness is private information.
When nursing a work-related illness or injury, seeking proper treatment is crucial, but sometimes costly. What’s more, getting compensated for other losses related to workplace accidents can also help you get back to your normal life. Do not be in a rush to settle, however.
Workers’ compensation adjusters can tell when claimants are eager to get compensated. So, they may try to get them to settle quickly for a lower amount. Settling too quickly may prevent you from recovering the full scope of your losses. Your employer and the insurance company are the only parties that will benefit if you agree to a quick settlement.
A workers’ compensation attorney can evaluate your case and determine reasonable compensation for losses. The amount should be enough to cover your medical treatment costs, pain and suffering, lost income, and other damages.
The workers’ compensation claims usually revolve around signing different forms for fact-checking and decision-making purposes. As such, expect the claims adjuster to ask you to sign certain forms. However, pay attention to the contents of the documents, since some may have incomplete or inaccurate information.
One of the paperwork errors to watch out for is the incorrect calculation of wage benefits. Discuss with your lawyer how to calculate your potential wage benefits, and have him or her crosscheck the figures in the form before signing.
Putting your signature on the documents is the same as agreeing to the terms stated. So, if a form has incorrect information about your claim, you may get less than what your employer owes you. Ask the adjuster to correct any details that seem inaccurate or incomplete before signing.
Insurance companies may sometimes schedule the claimants for an independent medical examination. This exam aims to determine whether your diagnosis for the work-related injury or illness was accurate. It is usually done by a doctor working in favor of the insurer.
The workers’ compensation claims adjuster might recommend this exam if the previous diagnosis concluded that you suffered a disability. It may also be recommended if your treating doctor referred you for further medical treatment.
Through the independent exam, the insurance can determine whether you are fit to resume work and ineligible for compensation. Since you cannot turn it down, only share pertinent information about the work injury during the independent exam. Any inconsistencies or dishonesty in your story may affect your entitlement to workers’ compensation benefits.
Since the law allows workers’ compensation insurance companies to have investigators monitor certain aspects of your life, you should not do anything that goes against your pursuit of compensation. The investigator will look for activities that are not in line with your claim and report them to the insurer. No one, not even the claims adjuster, will inform you that someone is watching you.
However, there are limits on the parts of a claimant’s life that investigators can monitor. The law, for instance, prohibits investigators from getting close to your home and spying on you through the windows. It also prohibits them from listening to private conversations or activities with loved ones.
If an investigator is hired to watch you, expect him or her to follow you in public places or interview your neighbors and family members to confirm the validity of your injury. Investigators also monitor social networking accounts. They usually watch out for recent videos or photos inconsistent with your physical health.
The insurer may lower your workers’ compensation benefits or reject your claim if the investigation reveals that you are not as injured or sick as you claim. Though rare, the company may also allege that you pursued a fraudulent compensation claim based on the investigation.
When speaking to a workers’ compensation adjuster, always focus on the claim’s facts. Avoid giving responses if a question seems incriminating. The insurer may use your testimony against you to turn down the claim.
Never lie about any pre-existing medical condition you might have. Remember, the adjuster will obtain your medical records for review. So, if you lie about your pre-existing medical condition, the insurer may disqualify your workers’ compensation claim.
Workers’ compensation adjusters are usually tactical with their interviewing approaches. They may compel you to disclose information that can hurt your compensation claim.
The adjuster may be casual and friendly during the call or meeting. If you get too comfortable with the conversation, you may mention something that compromises your claim.
Never respond to personal questions regarding your home life, finances, or family. Answering them will not help the investigation into your claim or reduce how long your claim will stay open.
You should also avoid putting your signature on any documents the adjuster asks you to sign if your lawyer is absent. Also, do not agree to any settlement offer unless your workers’ compensation attorney reviews the claim, estimates its worth, and advises you to accept the offer.
